Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus

Abstract

Background Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. Methods A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. Results Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. Conclusions Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.

Effects of Exercise Intervention on Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis of Controlled Trials

“…We found a statistically beneficial effect favoring exercise intervention with a medium effect size of 0.468. This finding agrees with previous systematic reviews of non-pharmacological interventions, including exercise, that it could improve quality of life in patients with SLE [ 13 , 14 ].…”

“…Another recent systematic review of 21 randomized controlled trials and two quasi-experimental studies in patients with SLE concluded that non-pharmacological interventions as an adjunct to usual medical care might be beneficial for improving patients’ quality of life and psychological outcomes. The interventions included two diet-based interventions, four psychological interventions, six physical activity interventions, and one self-management course [ 14 ]. Nevertheless, no meta-analysis assessing the effect of exercise on quality of life in patients with SLE is yet available.…”

“…[ 13 ]. To the best of our knowledge, the evidence of exercise on quality of life had only been summarized in systematic reviews, but not in meta-analyses, of non-pharmacological interventions in patients of SLE [ 13 , 14 , 16 ]. Therefore, this study aimed to specifically assess the effect of exercise intervention on quality of life in individuals with SLE using meta-analysis.…”

ACT for Lupus: Pilot Feasibility and Acceptability Study of a Novel Web‐Based Acceptance and Commitment Therapy Program for Patients With Lupus

“…Nonpharmacological interventions (eg, psychological, educational interventions) delivered remotely and in person have shown promise to improve QoL and psychological outcomes in patients with lupus (5). Acceptance and commitment therapy (ACT) is one therapeutic option that may be particularly well suited for the needs of patients with SLE.…”

The Outcomes of an e-Wellness Program for Lupus Patients in Thailand: A Participatory Action Research Approach

“…To prevent flare-ups or the exacerbation of lupus symptoms, a combination of medication treatments (e.g., antimalarials, glucocorticoids, and immunosuppressive agents) [ 15 , 16 ] and lifestyle changes (e.g., adherence to the medication regime, diet, sun exposure limitation, and stress management) should be used [ 17 , 18 ]. Furthermore, physical exercise and psychological interventions have been shown to improve symptoms of fatigue, depression, pain, and quality of life among lupus patients [ 17 , 19 ].…”