1. Systematic review:

Corinna Dressler, Jo Lambert, Lynda Grine, Paul Galdas, Carle Paul, Miriam Zidane, Alexander Nast
Journal der Deutschen Dermatologischen Gesellschaft (accepted).

Abstract

Psoriasis is a chronic inflammatory skin condition. Patient education may be one option to improve adherence and coping. The aim of this systematic review is to identify studies evaluating educational interventions for psoriasis patients. The review was conducted following the methods recommended by Cochrane. We searched seven databases, one trial register and three grey literature repositories. Data screening and extraction was done by two t reviewers independently. The risk of bias 2.0, ROBINS-I, NIH-tool were used. Additionally, the APEASE criteria were applied. We evaluat ed 16 studies. Two RCTs evaluated patient-practitioner or patient-nurse one-to-one interventions, one RCT assessed a web-based intervention, three RCTs reported group interventions taking place frequently; one RCT reported one-off group sessions. The remaining RCT compared the health care professionals involved. The risk of bias rating ranged from ‘some concerns’ to ‘high’. Three RCTs found an effect. We included 4 CCTs - one had an effect. One of 4 included before-after-studies warrants further investigation. Despite similarities in delivery mode across the interventions, patients eligible and settings in which interventions were delivered differed. Interventions that included an individual (one-to-one) session appear successful. Two interventions seem suitable for adaptation using APEASE: the topical treatment program (1, 2) and motivational interviewing after climate therapy(3, 4).
The review is being kept updated in form of a living systematic review. We will be searching for new studies every six months starting January 2019.

Table 1: Living Review History

Update 5:
Mota (5) evaluated the effect of several oral education sessions (30 minutes) on awareness of cardiovascular comorbidities amongst psoriasis patients. They report an improvement in knowledge of these comorbidities after the session and after six months. The impact on psoriasis or quality of life was not assessed. Our critical appraisal of the study lead to poor due to suboptimal reporting.

Update 3:
Najafi-Ghezeljeh(6) recruited patients hospitalized with psoriasis to participate in a self-management education intervention comprised of three group session and three telephone calls during which the disease, treatment options, lifestyle and behaviour were discussed. After 3 months, no difference between the intervention and the routine care groups based on final DLQI (mean difference -1.23 [-3.70; 1.24], but a difference was seen based on the mean change in PASI (- 4.21 [-7.81; -0.61]). The risk of bias evaluations lead to moderate for the outcome PASI and serious for the outcome DLQI (ROBINS-I for non-randomized studies). Authors gave no feedback.

Table 2: APEASE(7) evaluation of additional studies

References:
1. Reich K, Mrowietz U, Karakasili E, Zschocke I. Development of an adherence-enhancing intervention in topical treatment termed the topical treatment optimization program (TTOP). Arch Dermatol Res. 2014;306(7):667-76.
2. Reich K, Zschocke I, Bachelez H, de Jong EMGJ, Gisondi P, Puig L, et al. A Topical Treatment Optimisation Programme (TTOP) improves clinical outcome to calcipotriol/betamethasone gel in psoriasis: Results of the 64-week, multinational, randomized, phase IV study in 1790 patients (PSO-TOP). Br J Dermatol. 2017;177(1):197-205.
3. Larsen MH, Krogstad AL, Aas E, Moum T, Wahl AK. A telephone-based motivational interviewing intervention has positive effects on psoriasis severity and self-management: a randomized controlled trial. Br J Dermatol. 2014;171(6):1458-69.
4. Larsen MH, Wahl AK, Krogstad AL, Aas E. Cost-utility Analysis of Supported Self-management with Motivational Interviewing for Patients with Psoriasis. Acta Derm Venereol. 2017;96(5):664-8.
5. Mota F, Selores M, Torres T. Importance of educational sessions on cardiometabolic comorbidities. Awareness among psoriasis patients. Actas Dermo-Sifiliograficas. 2016;107(6):539-41.
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7. Michie S, Atkins L, West R. The behaviour change wheel : a guide to designing Interventions2014.
8. Bundy C, Kaur-Pinder B, Bucci S, Tarrier N, Griffiths CEM. Managing psychological morbidity in patients with psoriasis using a novel online treatment programme: the e-TIPs study. Br J Dermatol. 2011;165:54.
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11. Bostoen J, Geusens B, Lambert J, Bracke S, Dekeyser S. An educational program for patients with psoriasis and atopic dermatitis: A prospective randomized, controlled trial. J Am Acad Dermatol. 2012;1):AB84.
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14. Ersser SJ, Cowdell FC, Nicholls PG, Latter SM, Healy E. A pilot randomized controlled trial to examine the feasibility and efficacy of an educational nursing intervention to improve self-management practices in patients with mild-moderate psoriasis. J Eur Acad Dermatol Venereol. 2012;26(6):738-45.
15. Lora V, Gisondi P, Calza A, Zanoni M, Girolomoni G. Efficacy of a single educative intervention in patients with chronic plaque psoriasis. Dermatology. 2009;219(4):316-21.
16. Bremer Schulte M, Cormane RH, van Dijk E, Wuite J. Group therapy of psoriasis. Duo formula group treatment (DFGT) as an example. J Am Acad Dermatol. 1985;12(1 Pt 1):61-6.
17. Fortune DG, Richards HL, Griffiths CE, Main CJ. Targeting cognitive-behaviour therapy to patients’ implicit model of psoriasis: Results from a patient preference controlled trial. Br J Clin Psychol. 2004;43(1):65-82.
18. Fortune DG, Richards HL, Kirby B, Bowcock S, Main CJ, Griffiths CEM. A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy. Br J Dermatol. 2002;146(3):458-65.
19. Pagliarello C, Calza A, Armani E, Di Pietro C, Tabolli S. Effectiveness of an empowerment-based intervention for psoriasis among patients attending a medical spa. Eur J Dermatol. 2011;21(1):62-6.
20. Renzi C, Di Pietro C, Gisondi P, Chinni LM, Fazio M, Ianni A, et al. Insufficient knowledge among psoriasis patients can represent a barrier to participation in decision-making. Acta Derm Venereol. 2006;86(6):528-34.
21. Burnett CJ, Gordon K, Kundu RV. Psoriasis and cardiometabolic disease: An educational and teaching intervention on cardiometabolic risks. J Am Acad Dermatol. 2015;1):AB101.
22. Burnett CJ, West DP, Rademaker AW, Kundu RV. Psoriasis and Cardiometabolic Disease: A Brief, Focused, Educational Intervention on Cardiometabolic Risks. Journal Of Drugs In Dermatology. 2016;15(10):1176-80.
23. de Korte J, Van Onselen J, Kownacki S, Sprangers MAG, Bos JD. Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme. J Eur Acad Dermatol Venereol. 2005;19(1):35-41.
24. Tucker R, Stewart D. Assessing the impact of community pharmacist led educational advice on knowledge, disease severity and quality of life in patients with mild to moderate psoriasis. Int J Pharm Pract. 2016;24:22.
25. Wahl AK, Moum T, Robinson HS, Langeland E, Larsen MH, Krogstad AL. Psoriasis Patients’ Knowledge about the Disease and Treatments. Dermatol Res Pract. 2013;2013:921737-.

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