Stimulating active coping in patients with rheumatic diseases: a systematic review of controlled group intervention studies

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Abstract

Teaching patients with rheumatic diseases to cope actively with their problems may increase the social support they receive and, also, the quality of their lives. In this paper, a systematic review of coping interventions for people with rheumatic diseases is described. Fourteen controlled trials were selected. Effects on quality of life have been measured in 13 studies of which 6 found positive effects. Effects on social support have been found in one of four studies investigating this variable. Coping has been measured in three studies with effects found on active coping in one study. There is a need for well-designed research on the effects of active coping in people with rheumatic diseases, as this may open new perspectives in patient education.

Introduction

Most educational interventions for people with rheumatic diseases are hybrids. It is possible, however, to identify key components. Seemingly dissimilar programs may actually achieve their effects because of a certain element they share. Identifying this element and its effects may facilitate the construction of new interventions that make maximal use of effective intervention components to reach desired outcomes.

There are many group interventions for people with rheumatic diseases, which in some way stimulate participants to cope actively. Active coping may have a positive effect on social support [1], [2], and also on quality of life [3], [4]. Interventions aimed at increasing active coping in people with rheumatic diseases are recommended because there are indications that passive coping has negative effects for the patients (e.g. depression, pain, functional disability) [5], [6], [7]. The methodology of the systematic review has been applied to find out if group interventions in which patients with rheumatic diseases are stimulated to cope actively, increase active coping, social support received, and/or quality of life. The importance of reviewing trials for finding evidence for positive effects of active coping, lies in possible new perspectives in patient education. If active coping actually leads to a higher degree of support from people in the environment and to improving the patients’ quality of life, and group interventions are successful in increasing active coping, teaching patients to cope actively becomes a very useful component in patient education.

In this review, supportive interactions are conceived as indicators of social support and social network is perceived as an indirect measurement of social support. Quality of life in people with rheumatic diseases can be health-related, indicating the physical, psychological and social status of the patient [8], [9], as well as covering evaluations of happiness in life and satisfaction with life as in subjective well-being [10], [11]. Consequently, studies using these concepts as outcome measures are included.

The purpose of the review is to provide practitioner and research readers with information about effects on coping, social support and quality of life of coping interventions for people with rheumatic diseases, to consider the practice implications of the effects found, and to make recommendations for future research.

Section snippets

Methods

The review followed the procedures outlined for systematic reviews [12], [13], [14].

Results of the search strategy

The search for studies resulted in >500 unduplicated titles. A screening of the titles and abstracts of these articles led to a selection of 30 possibly relevant articles. Of these 30 studies, 16 [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37] met the selection criteria described in Section 2.2. In most of the excluded studies [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], the reason for exclusion was that the

Discussion and conclusion

The heterogeneity of the interventions and of operationalizations of outcome measures in the trials included in this systematic review makes a mathematical synthesis of intervention effects inappropriate. Consequently, the results from the trials have been discussed in narrative form.

The results of the individual studies illustrate that in general, coping and social support were seldom outcome variables in the studies under review. Indicators of quality of life, on the other hand, were measured

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