Psychological Interventions for Rheumatoid Arthritis: Examining the Role of Self-Regulation With a Systematic Review and Meta-Analysis of Randomized Controlled Trials
Psychological Interventions for Rheumatoid Arthritis: Examining the Role of Self-Regulation With a Systematic Review and Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1002/acr.20251
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发表时间：
2010-10-01
影响因子：
4.7
通讯作者：
De Gucht, Veronique
中科院分区：
文献类型：
--
作者：
Knittle, Keegan;Maes, Stan;De Gucht, Veronique
目标。目的探讨心理干预对类风湿关节炎（RA）的疗效，并确定自我调节干预是否优于其他心理治疗。只有随机对照试验测试面对面的心理干预RA患者纳入。两名独立研究人员提取了相关研究数据，对每项研究的方法学质量进行了评分，并评估了每个治疗条件，包括来自自我调节理论的5种行为改变技术（目标设定、计划、自我监控、反馈和复发预防）。纳入了27项试验，并计算了5个结果的累积效应量。在治疗后的身体活动（0.45）、疼痛（0.18）、残疾（0.32）、抑郁症状（0.23）和焦虑（0.17）方面发现显著效应量（Hedges' g）。在随访期间（2-14个月），身体活动（0.36）、疼痛（0.13）、残疾（0.15）和抑郁症状（0.32）获得显著效应量。比较分析显示，使用更多自我调节技术的干预措施比使用较少此类技术的干预措施更能显著减少抑郁症状和焦虑。此外，与长期RA患者相比，近期确诊RA患者的抑郁症状明显减轻。心理干预对许多类风湿性关节炎患者是有益的，特别是当涉及到增加身体活动水平时。来自自我调节理论的干预技术似乎在减轻RA患者的抑郁症状和焦虑方面发挥作用。
Objective. To examine the efficacy of psychological interventions for rheumatoid arthritis (RA), and to determine whether self-regulation interventions demonstrate efficacy superior to that of other psychological treatments.Methods. Only randomized controlled trials testing a face-to-face psychological intervention among patients with RA were included. Two independent investigators extracted pertinent study data, rated each study on a scale of methodologic quality, and assessed each treatment condition for its inclusion of 5 behavior-change techniques derived from self-regulation theory (goal setting, planning, self-monitoring, feedback, and relapse prevention).Results. Twenty-seven trials were included, and cumulative effect sizes were calculated for the 5 outcomes. Significant effect sizes (Hedges' g) were found at posttreatment for physical activity (0.45), pain (0.18), disability (0.32), depressive symptoms (0.23), and anxiety (0.17). At followup (range 2-14 months), significant effect sizes were obtained for physical activity (0.36), pain (0.13), disability (0.15), and depressive symptoms (0.32). Comparative analyses revealed that interventions utilizing more self-regulation techniques reduced depressive symptoms and anxiety significantly more than interventions utilizing fewer such techniques. Additionally, depressive symptoms were reduced significantly more among recently diagnosed RA patients than among those with longstanding RA.Conclusion. Psychological interventions are beneficial for many patients with RA, particularly when it comes to increasing physical activity levels. Intervention techniques derived from self-regulation theory appear to play a role in reducing depressive symptoms and anxiety among patients with RA.