• Digital-based self-management interventions for people with osteoarthritis: Systematic review with meta-analysis

      Safari, Reza; Jackson, Jessica; Sheffield, David; University of Derby (JMIR Publications Inc., 2020-06)
      Osteoarthritis (OA) is not curable but the symptoms can be managed through Self-management programmes. Due to the growing burden of arthritis to the health system, and the need to ensure high quality integrated services, delivering Self-management programmes through digital technologies could be an economic and effective community-based model of care. To analyze the effectiveness of digital-based self-management programs on patient outcomes in people with OA. Seven online databases and three grey literature databases were searched for randomized controlled trials (RCT) assessing digital-based structured self-management programs (D-SMP) on self-reported outcomes including pain, function, disability, and health-related quality of life in people with OA. Two reviewers independently screened the search results and reference list of identified papers and related reviews. Data about the intervention components and delivery, and behavioral change techniques were extracted. Meta-analysis, risk of bias sensitivity analysis and subgroup analysis were performed where appropriate. The GRADE approach was used to assess the quality of evidence. Eight studies were eligible including 2687 people with OA. Self-management programs were delivered via telephone plus audio/video, internet or mobile app. D-SMP compared to Treatment As Usual control group resulted in a significant, homogeneous, moderate reduction in pain (SMD -0.28, 95% CI -0.38 to -0.18) and improvement in physical function (-0.26 95% CI -0.35 to -0.16) at post-treatment. The D-SMP effect reduced slightly at 12 months follow-up but remained significant and moderate. Using the GRADE approach, the quality of evidence was rated as ‘moderate’. D-SMPs may result in a moderate improvement in pain symptoms and function in people with OA delivered. Further research is required to confirm the findings of the review and assess the effects of D-SMPs on other health-related outcomes. Clinical Trial: PROSPERO: CRD42018089322
    • Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis

      Moss-Moris, R; Harrison, A.M; Safari, Reza; Norton, S; van der Linden, M.L; Picariello, F; Thomas, S; White, C; Mercer, T; University of Derby (Elsevier, 2019-08-28)
      Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.