Effectiveness of patient education on the quality of life of patients with rheumatoid arthritis: A systematic review and meta-analysis

Background: Rheumatoid arthritis (RA) has a considerable negative impact on quality of life (QoL) and represents a significant burden on healthcare systems worldwide. Although patient education (PE) programs are advocated as an integral component of comprehensive RA management, the magnitude and sustainability of their QoL benefits remain unclear. This meta-analysis seeks to assess the efficacy of PE interventions in enhancing QoL among RA patients. Methods: A comprehensive review of studies from 1985 to 2022 was conducted, incorporating 66 publications (59 randomized controlled trials and 7 non-randomized controlled trials) with a total of 9622 participants. Studies were selected based on predefined inclusion criteria, focusing on adults diagnosed with RA who participated in PE interventions compared to conventional or no interventions. Data were analyzed using fixed- effect and random-effects models, depending on the heterogeneity among studies. Results were reported separately for the initial follow-up and for the final follow-up. Findings: PE interventions demonstrated a positive impact on QoL. Following the intervention, there is a significant improvement in QoL (SMD = 0.13, 95% CI: 0.08 to 0.17, I-2 = 43%), with the highest efficacy observed at 7-12 weeks. Modern-era publications and randomized controlled trials offer more consistent results. Subgroups with higher female representation (>85%) and combined intervention approaches show more substantial effects. In the final assessments, QoL improvements are noteworthy, especially within the 0-6 weeks post-intervention period (SMD = 0.39, 95% CI: 0.13 to 0.66, I-2 = 84%). Younger adults (<= 50 <= 50 years) benefit the most, while longer program durations (>52 weeks) exhibit significant but varied effects. Interpretation: This meta-analysis underscores the positive effect of PE interventions on QoL among RA patients, highlighting the importance of tailored approaches considering various contextual factors. Standardizing intervention protocols and optimizing delivery methods are recommended to enhance the sustained impact of PE programs in RA management.