Effectiveness of education programs on axSpA patients: a systematic review of randomized controlled trials

Introduction: The current standard of care of patients with spondyloarthritis (SpA), in addition to pharmacological treatment, includes regular exercise and patient education.(1) The primary goal of this systematic literature review (SLR) is to update the evidence of the effectiveness of education programs for patients with axial SpA (axSpA). Methods: We systematically searched three databases, PubMed, Embase and Web of Science Core Collection, from January 2000 to June 2023, using the following terms: “patient education”, “patient counselling”, “patient teaching”, “patient engaging”, “patient empowerment”, “health education”, “spondyloarthritis”, “spondyloarthropaties”, “spondylitis” and “ankylosing spondylitis”. The “Population (P)”, “Intervention (I)”, “Comparator (C)”, “Outcome (O)”, PICO criteria were used. “P”, defined as axSpA, “I” as education, “C” as standard of care or physical exercise and “O” as disease activity, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS); disease functional repercussion, Bath Ankylosing Spondylitis Functional Index (BASFI); disease metrological repercussion, Bath Ankylosing Spondylitis Metrological Index (BASMI); disease quality of life Ankylosing Spondylitis Quality of Life (ASQoL), EuroQol-5D (EQ-5D) and Short Form 36 Health Survey (SF36); disease economic impact, cost-utility, cost-benefit and incremental cost-effectiveness ratio (ICER). Only randomized clinical trials were included. Two reviewers independently assessed the identified papers according to the established criteria and extracted the data. Results: From the initial 494 studies identified, 6 were selected for data extraction and qualitative analysis. The study sample sizes ranged between 41-65 individuals, all diagnosed with ankylosing spondylitis. The leaders of the programs varied, the intervention period ranged between 4-12 weeks and the follow up ranged between 3-12 months. In three studies, the comparator was standard of care, and in the other three was physical exercise. Overall, there was an improvement in BASDAI, BASFI, BASMI, ASQoL and SF-36, after the application of educational programs. No studies evaluated the economic impact of educational programs. Conclusion: Education appears to be an important adjuvant as non-pharmacological treatment for patients with axSpA, enhancing various disease outcomes, particularly when delivered by Health Professionals using physical materials such as pamphlets. However, there is an ongoing need for additional research to obtain more robust conclusions.