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Eczema Cochrane Review RoB files

Singleton, Heidi and Hodder, Andrew (2024) Eczema Cochrane Review RoB files.
Excel RoB files for the following Cochrane Abstract. Educational and psychological interventions for managing eczema Background: Atopic dermatitis can have significant impact on both wellbeing and quality of life for patients and their families. Standard treatment is with trigger/irritant avoidance and regular application of emollients and topical steroids or calcineurin inhibitors. Thorough physical and psychological assessment is central to informing good quality treatment. Overcoming barriers to provision of holistic treatment in dermatological practice, is dependent on evaluation of the efficacy and economics of both psychological and educational interventions in this patient group. Objectives: 1. To assess the clinical outcomes of educational and psychological interventions in children and adults with atopic dermatitis 2. To summarise the availability and principal findings of relevant economic evaluations Search Methods: The Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, APA PsycINFO and two trials registers were searched up to March 2023. We checked the reference lists of included studies and related systematic reviews for further references to relevant randomised controlled trials (RCTs) and contacted experts in the field to identify additional studies. NHS EED, MEDLINE and Embase were searched for economic evaluations on 8 June 2022. Selection Criteria: Randomised, cluster‐randomised and crossover randomised controlled trials (RCTs); that assess educational and psychological interventions for treating atopic dermatitis in children and adults. Data Collection and Analysis We used standard Cochrane methods, with GRADE to assess the quality of the evidence for each outcome. Primary outcomes were reduction in disease severity, as measured by clinical signs and as measured by patient‐reported symptoms and improvement in quality‐of‐life measures. Secondary outcomes were improvement in long‐term control of atopic dermatitis symptoms, improvement in psychological well‐being measures, improvement in standard treatment concordance and adverse events. Main results: We included 37 trials (6170 participants). Most trials were conducted in high‐income countries (34/37), in outpatient settings (25/37). We judged only three trials to be low risk of bias across all domains. Fifteen trials had high risk of bias in at least one domain, mostly due to bias in measurement of the outcome. For the face to face education outcome, in relation to disease severity as measured by clinical signs SCORAD (2 RCTs, 215 participants): compared to standard care, face to face education intervention probably reduces disease severity (MD: -6.09, 95% CI: -9.05 to -3.14). The GRADE assessment was moderate. For the group education outcome, in relation to disease severity as measured by clinical signs SCORAD, there were 1424 participants from 3 RCTs. Compared to standard care, group education intervention probably reduces disease severity for all ages on the long run (MD: -7.22, 95% CI: -11.01 to -3.43). With regards to disease severity as measured by patient reported symptoms POEM there were 1068 participants from 4 RCTs. Compared to standard care, group education intervention probably reduces disease severity (MD: -2.54, 95% CI: -3.78 to -1.31). Relating to the technology-mediated education outcome, for disease severity as measured by clinical signs SCORAD results were from 1 RCT with 29 participants. Compared to standard care, due to a very low certainty evidence, we are unable to comment on whether technology-mediated education intervention could reduce disease severity (MD: 4.58, 95% CI: -11.51 to 20.6). In relation to disease severity as measured by patient reported symptoms- POEM, results came from 2 RCTs with 195 participants. Compared to standard care, technology mediated education intervention may have little or no effect on the reduction of disease severity (MD: -0.76, 95% CI: -1.84 to 0.33). Only one study contributed data relating to the habit reversal treatment outcome with a total of 33 participants. Compared to standard care, habit reversal treatment intervention may reduce disease severity as measured by clinical signs-SCORAD (MD: -6.57, 95% CI: -13.04 to -0.1) Analysis 4.1. Compared to standard care, habit reversal treatment intervention may have little or no improvement in quality of life (MD: -0.41, 95% CI -2.15 to 1.33). Three studies contributed data to the arousal reduction therapy outcome with a total of 33 participants. with regards to disease severity as measured by clinical signs (EASI) results came from 24 participants in one RCT. Compared to standard care, we were uncertain whether arousal reduction therapies intervention could reduce disease severity (MD: 0.2, 95% CI: -3.7 to 4.1). No studies were found to measure quantitatively the following interventions versus the standard care: self-help psychological interventions, psychological therapies and printed education. No adverse events were reported in any of the studies. Conclusions: Direct person education, as an adjunct to conventional topical therapy, probably reduces disease severity compared to standard care, and habit reversal may reduce disease severity. Group education probably reduces patent-reported symptoms. These favourable effects are of uncertain clinical significance, since they are close to the minimally clinically important difference for the outcome measures used. We found insufficient evidence for technology-mediated education or arousal reduction interventions. Consideration should be given to dose effect (frequency, duration and follow ups) and to the preferences of patients for F2F verses group delivery, such as the desire to receive group education or F2F delivery alongside another group of patients. Future trials need to evaluate long term clinical benefit of psychological and educational interventions. The limited health economic evidence suggests that the costs of care provided by the NPs were lower than care provided by the dermatologists, yet with comparable effectiveness. There is a need for comparative studies evaluating the effectiveness and cost-effectiveness of F2F verses group educational and psychological interventions to supplement atopic dermatitis management. The vast majority (92%) of the included trials were conducted in high‐income countries. In terms of ethnicity, most studies did not report detailed information on the ethnicity of participants; where ethnicity was reported the participants were predominantly white. Atopic dermatitis in darker skin may present differently to eczema in white skin. Future trials should include more diverse patient populations and settings including lower income countries. Future research should reflect the patient and clinician perceived gaps in clinical evidence and ensure that patients are involved in trial design.
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