Systematic review of self-management interventions for people with eczema

Abstract

Eczema is a common, long-term condition but inadequate support and information can lead to poor adherence and treatment failure. We have reviewed the international literature of interventions designed to promote self-management in adults and children with eczema. MEDLINE, MEDLINE in process, EMBASE, CINAHL and GREAT were searched from their inception to August 2016 for randomised controlled trials. Two authors independently applied eligibility criteria, assessed risk of bias for all included studies and extracted data. Twenty studies (3028 participants) conducted in 11 different countries were included. The majority (18) were based in secondary care and most (16) targeted children with eczema. Reporting of studies, including descriptions of the interventions and the outcomes themselves, was generally poor. Thirteen studies were face-to-face educational interventions, five delivered online and two were of written action plans. Follow-up in most studies (12) was short-term (up to 12 weeks). Only six trials specified a single primary outcome. There was limited evidence of effectiveness. Three studies collected and reported any outcomes related to cost and just one study undertook any formal cost-effectiveness analysis. In summary, we have identified a general absence of well conducted and reported RCTs with a strong theoretical basis. There is therefore still uncertainty about how best to support self-management of eczema in a clinically and cost effective way. Recommendations on design and conduct of future trials are presented.

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