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Table 3 Study Characteristics

From: Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials

Author & Location Participant Demographics Intervention Length, Content & Groups Measures & Follow-up Reported Results Authors’ Conclusions
Baptist et al. [82]; Nether-lands
(RCT)
N = 70, female 77%, ≥65 years, asthma.
Attrition 10%
6-week health educator-led self-regulation intervention; two conditions:
1. Self-regulation training (i) 3-weekly health education group sessions (ii) 3-weekly one-on-one telephone sessions
2. UCC
Measured 0, 1, 6 and 12 months post-intervention. Assessed on:
1. Asthma-related QOL (MAQLQ), including individual components of activity, emotions, environment and symptoms
2. Asthma-related control (ACQ)
3. Hospitalisations
4. Emergency department visits
Significance Level Employed: p ≤ 0.05 [Effect sizes not reported]
1. Significant intervention effects for overall asthma related QOL 1 month (p < 0.001), 6 months (p = 0.031) and 12 months post-intervention (p = 0.045)
2. Significant individual intervention effects:
(i) 1 month post-intervention for QOL symptoms (p = .001) and environment (p = 0.001)
(ii) 12 months post-intervention for QOL activity (p = 0.04)
3. Significant intervention effects for asthma-related control 1 month (p = .03) and 12 months (p = 0.02), but not 6 months (p = 0.21), post-intervention
4. Significant intervention effect for hospitalisations at 12 (p = 0.04), but not 6 months (p = 0.07), post-intervention
5. Non-significant intervention effects at all time points for asthma-related QOL emotions (0.38 ≥ p ≥ 0.07) and emergency department visits (0.58 ≥ p ≥ 0.54)
“By targeting a disease from an individual’s perspective rather than illness from a physician’s perspective, this intervention is ideally suited to improve outcomes in elderly adults.”
Blank et al. [83];
USA
(RCT)
N = 238, female 46%, ≥18 years, HIV.
Attrition QOL 25%, biomarker 39%
12 month community-based nurse management of mental and medical conditions; two conditions:
1. Weekly psycho-education and symptom management meeting with a community nurse
2. UCC (PATH+ pathway)
Measured at baseline, 3, 6, 12 (end of intervention) and 24 months (12 post-intervention). Assessed on:
1. Health-related QOL (SF-12), including mental and physical health
2. HIV biomarkers (HIV viral load, CD4)
Significance Level Employed: p < .05
1. Model A: viral load and SF-12 mental outcomes 12 months post-intervention
(i) Viral load treatment effect on β = − 0.138 (p < 0.05)
(ii) Mental treatment effect on β = 0.91 (p < 0.05)
(iii) Goodness of fit significant: p = 0.01; RMSEA = 0.055 (0.027, 0.080)
2. Model B: CD4 and SF-12 meant outcomes 12 months post-intervention
(i) CD4 treatment effect on β = 0.486 (p ≥ 0.05)
(ii) Mental treatment effect on β = 0.91 (p < 0.05)
(iii) Goodness of fit significant: p = 0.04; RMSEA = 0.049 (0.018, 0.075)
3. Model C: viral load and SF-12 physical outcomes 12 months post-intervention
(i) Viral load treatment effect on β = − 0.136 (p < 0.05)
(ii) Physical treatment effect on β = − 0.42 (p ≥ 0.05)
(iii) Goodness of fit significant: p = 0.01; RMSEA = 0.058 (0.082, 0.083)
4. Model D: CD4 and SF-12 physical outcomes 12 months post-intervention
(i) CD4 treatment effect on β = 0.485 (p ≥ 0.05)
(ii) Physical treatment effect on β = − 0.42 (p ≥ 0.05)
(iii) Goodness of fit non-significant: p = 0.10; RMSEA = 0.045 (0.009, 0.072)
“Implementation of community-based nurse disease management for this population and other complex patient populations may have significant impact on viral load, immune functioning, and health-related quality of life.”
Escobar et al. [84];
USA
(RCT)
N = 172; Female 88%, 18–75 years; MUPS.
Attrition 45%
3-month cognitive behavioural therapist-led CBT intervention; two conditions:
1. 10 sessions of structured CBT and a consultation letter
2. UCC (and a consultation letter)
Measured pre-intervention (baseline), immediately, and 6 months post-intervention. Assessed on
1. Severity of somatic symptoms (PHQ-15 scale of PRIME-MD) and current somatic symptoms (VAS)
2. Functional status (physical functioning subscale from MOS-10)
3. Anxiety (HAM-A)
4. Depression (HAM-D)
Significant Level Employed: p < .05 [Effect sizes not reported]
1. Significant intervention effects:
(i) Immediately post-intervention for severity of somatic symptoms (p = 0.1), current somatic symptoms (p = 0.01) and depression (p = 0.2)
(ii) 3 months post-intervention for severity of somatic symptoms (p = 0.03)
2. Significant group-by-time intervention effect for severity of somatic symptoms (p = 0.03) immediately post-intervention
3. The intervention non-significantly affected all other outcomes (p = unspecified)
“...with proper training of clinicians, the intervention described herein should be relatively easy to implement in many primary care settings... therefore needs to be considered for future studies as well as for current practice.”
Smeulders et al. [85];
Nether-lands
(RCT)
N = 317, Female 27%, ≥ 18 years; CHF.
Attrition 16%
6-week cardiac nurse and peer role model co-facilitated structured self-management programme; two conditions:
1. Weekly 2.5-h structured self-management programme
2. UCC
Measured pre-intervention (baseline) and immediately, 6 months and 12 months post-intervention. Assessed on:
1. Psychosocial attributes, including general self-efficacy (GSES) and cardiac-specific self-efficacy (CSE)
2. Perceived control (PM)
3. Cognitive symptom management (Coping with symptoms scale of ASES)
4. Self-care behaviour (EHFScBS)
5. QOL, including general QOL (RAND-36), cardiac-specific QOL (KCCQ), perceived autonomy (VAS), and anxiety and depression (HADS)
Significance Level Employed: p ≤ 0.05
1. Significant intervention effects immediately post-intervention for:
(i) Cardiac-specific QOL (p = 0.005, d = 0.06).
(ii) Cognitive symptom management (p = 0.008, d = 0.34)
(iii) Self-care behaviour (p = 0.008, d = 0.18)
2. Non-significant intervention effects were present immediately, 6 months, and 12 months post-intervention for all other measures (0.986 ≥ p ≥ 0.052)
“...this programme was considered feasible by both programme leaders and participants... but showed limited, mainly short-term effects...”
“More effective alternatives need to be found in nursing care to support self-management behaviour by patients...”
Somers et al. [86];
USA
(RCT)
N = 232, Female 79%, ≥ 18 years; Knee osteoarthritis.
Attrition 30%
24-week clinical psychologist-led PCST and BWM programme; 4 conditions:
1. PCST– 12 60-min weekly group sessions followed by 12 biweekly sessions
2. BWM programme – 12 60-min weekly group sessions followed by 12 biweekly sessions
3. Combined PCST/BWM programme
4. UCC
Measured pre-intervention, and immediately, 6 months and 12 months post-intervention. Assessed on:
1. Pain, physical disability and psychological disability (AIMS, WOMAC)
2. Gait velocity (WOMAC)
3. Pain catastrophizing (Catastrophizing scale of CSQ)
4. Self efficacy, including arthritis self-efficacy (ASES) and weight self-efficacy (WEL)
5. Weight (kg) and BMI (kg/m)
Significance Level Employed: p < .05 [Effect sizes not reported]
1. Significant overall treatment effect 12-months post-intervention for:
(i) Pain (AIMS: p = 0.007; WOMAC: p = 0.0002)
(ii) Physical disability (AIMS: p < 0.0001; WOMAC: p < 0.0001)
(iii) Stiffness/Gait velocity (p = 0.0017)
(iv) Pain catastrophizing (p = 0.02)
(v) Arthritis self-efficacy (p < 0.0001) and weight self-efficacy (p = 0.0002)
(vi) Weight (p < 0.0001) and BMI (p < 0.0001)
2. The combined PCT/BWM intervention significantly improved outcomes 12-months post-intervention compared with:
(i) BWM for pain (AIMS: p = 0.01; WOMAC: p = 0.002), physical disability (AIMS: p < 0.0001; WOMAC: p < 0.0001), stiffness/gait velocity (p = 0.004), pain catastrophizing (p = 0.008), arthritis self-efficacy (p = 0.0002), weight self-efficacy (p = 0.003), weight (p = 0.0014) and BMI (p = 0.0004).
(ii) PCST for pain (WOMAC: p = 0.01), physical disability (AIMS: p < 0.0001; WOMAC: p = 0.0001), stiffness/gait velocity (p = 0.02), psychological disability (p = 0.05), arthritis self-efficacy (p = 0.004), weight self-efficacy (p = 0.02), weight (p < 0.0001) and BMI (p < 0.0001)
(iii) UCC for pain (AIMS: p = 0.02; WOMAC: p = 0.0002), physical disability (AIMS: p < 0.0001; WOMAC: p = 0.0001), stiffness/gait velocity (p = 0.02) pain catastrophizing (p = 0.04), arthritis self-efficacy (p < 0.0001), weight self-efficacy (p = 0.0001), weight (p < 0.0001) and BMI (p < 0.0001)
3. The combined PCST/BWM intervention non-significantly affected all other outcomes 12-months post-intervention (0.98 ≥ p ≥ 0.16)
“...significant benefits are provided by simultaneously training overweight and obese OA patients to increase the effectiveness of their pain coping skills and manage their weight.” “It may be that PCST gives patients pain coping skills, which enhances their ability to comply with the needed lifestyle changes to lose weight (i.e., increasing activity, decreasing eating).
Van Der Meulen et al. [87]
Nether-lands
(RCT)
N = 205, female 30%, ≥ 18 years; HNC.
Attrition 13%
12-month nurse-led counselling intervention for depressive symptoms; two conditions:
1. 6 bimonthly 45–60 min psychosocial sessions (and a regular medical follow-ups)
2. UCC (regular medical follow-ups)
Measured pre-intervention (baseline), and during the intervention at 3, 6 and 9 months. The primary assessment end-point was immediately post-intervention (i.e. 12 months after baseline). Assessed on:
1. Depression (CES-D)
2. Physical symptom related QOL (EORTC QLQ), including pain, swallowing, senses, speech, teeth, opening mouth, dry mouth, sticky saliva, and coughing
Significance Level Employed: p ≤. 05 [Exact significance values and effect sizes not reported; between-group change means (CI 95%) listed instead]
1. Significant intervention effect immediately post-intervention for:
(i) Depressive symptoms in the overall sample (∆ mean = − 2.8) and depressive sub-group (∆ mean = − 5.2)
(ii) Overall physical symptoms in the overall sample (∆ mean = unspecified) and depressive sub-group (∆ mean = unspecified)
(iii) Physical symptoms of pain (∆mean = − 9.9), swallowing (∆mean = − 8.0), opening mouth (∆mean = − 14.6) and coughing (∆mean = 10.9) in overall sample
(iv) Physical symptom of opening mouth (∆ mean = − 23.2) for the depressive sub-group
2. 2. Non-significant intervention effects were present for all other measures (10.5 ≥ ∆ mean ≥ − 10.6)
“...psychotherapeutic interventions are effective in reducing depressive symptoms in general cancer patients.”
“...NUCAI is feasible and effective for reducing depressive symptoms of patients with HNC, particularly for those with raised levels of depression symptoms.”