Psychological and educational interventions for atopic eczema in children
Abstract
Background
Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children.
Objectives
To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema.
Search methods
We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966‐2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On‐line: National Research Register, Meta‐register of Controlled Trials, ZETOC alerts, SIGLE (August 2005).
Selection criteria
RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema.
Data collection and analysis
Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis.
Main results
Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video‐based education more effective in improving severity than direct education and the control (discussion) (p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042).
Authors' conclusions
A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi‐professional eczema school and nurse‐led clinics) require further and comparative evaluation to examine their cost‐effectiveness and suitability for different health systems.
PICOs
Plain language summary
Psychological and educational interventions for atopic eczema in children
Atopic eczema is an itchy inflammatory skin condition which affects the quality of life of children with eczema and their parents; it can affect up to 15% of school children in the UK. Psychological and educational approaches to treating eczema have been used to complement medication in managing eczema by, for example, promoting relaxation and educating parents and children to understand the condition and their role in its successful management. However, the effectiveness of these approaches has not been systematically reviewed.
The main finding of the review is that there is currently only limited research evidence about the effectiveness of educational and psychological approaches when used with medicines for the treatment of childhood eczema. We were only able to include one study on the effectiveness of psychological approaches in the review. We included four educational studies, of which three identified that education decreased the severity of the eczema, and one study found that education improved quality of life for parents of children with eczema. Relaxation methods reduced the severity of the eczema, compared to discussion only, in the psychological study. Two different approaches have been used to deliver education; one led by a nurse and the other by a team of health professionals.
Due to weaknesses in the quality of most of the research studies and the fact that different measures were used to evaluate effectiveness of the approaches, we cannot draw strong conclusions about whether psychological and educational approaches work or which is the best approach to use. More details are needed about the psychological and educational approaches used, to allow a greater understanding of the key factors that might help reduce eczema. Better description of the research methods used are also needed. Research priority should also be given to comparing the relative cost effectiveness of health professionals educating parents either in teams or by nurses alone.
No adverse effects have been reported.
Limitations of the review: We were able to find only five studies eligible for inclusion in the review and we were not able to combine findings from these studies due to the different ways in which effectiveness of the approaches were measured.
