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A Systematic Review of Non-Pharmacological Interventions for Primary Sjögren's Syndrome

Lookup NU author(s): Dr Katie Hackett, Dr Katherine Deane, Vincent Deary, Emerita Professor Julia Newton, Professor Tim Rapley, Professor Fai NgORCiD


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Background People with primary Sjögren’s syndrome (PSS) suffer with a range of symptoms including dryness, pain, fatigue, autonomic dysfunction, low mood and functional impairment. Non pharmacological interventions such as physiotherapy, occupational therapy, complimentary therapies, devices and psychotherapy aim to relieve symptoms and improve function. We conducted a systematic review of these interventions’ efficacy and registered the protocol in advance with PROSPERO (CRD42013004997). Methods Search strategy Databases were searched from inception to July 2013 with a pre-defined list of search terms: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, PsychINFO, Cinahl, AMED, CCTR, WHO ICTRP, UCLRN and the National Research Register Archive and reviewed the reference lists of included studies. Selection criteria Studies were included if they were randomised controlled trials (RCTs) of any non-pharmacological interventions for adults with PSS. Any comparator was allowed. Titles and abstracts of studies were considered according to the inclusion/exclusion criteria. Full texts were reviewed independently by two authors for inclusion or exclusion. Data abstraction Two review authors separately extracted the data the included studies on a standardised form. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes fell within the main domains addressed by the World Health Organisation International Classification of Functioning. Results 996 studies were identified of which 17 full text articles were screened and 5 studies were included in this review with a total of 130 participants randomised. The included studies investigated effectiveness of an oral lubricating device for dry mouth (Frost 2006), acupuncture for dry mouth (List 1998), lacrimal punctum plugs for dry eyes (Mansour 2007, Qui 2013) and psychodynamic group therapy for coping with symptoms (Poulson 1991). Frost showed that salivary flow and speed of speech improved with the oral lubricating device but this small study (n=29) was at high risk of bias. Mansour investigated punctum plugs but had no extractable data whereas Qui compared punctum plugs to artificial tears reported improvements in most outcomes in both groups, but significantly better results in the punctum plugs group on tear volume and stabilising tear film. The Qui study was of good quality but too small (n=42) for these results to be regarded as definitive. Poulson showed no advantage of psychodynamic therapy over the untreated control group in a small (n=18) poor quality study. Conclusions Although one study showed punctum plugs to be better at improving dry eyes it was too small for the findings to be conclusive. Therefore overall we identified no evidence to support any non-pharmacological interventions to improve PSS. The area needs good quality large RCTs that are reported according to CONSORT guidelines. ADDIN EN.REFLIST

Publication metadata

Author(s): Hackett KL, Deane KHO, Deary V, Newton JL, Rapley T, Ng W-F

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Rheumatology 2014

Year of Conference: 2014

Pages: i135-i135

Print publication date: 01/04/2014

Online publication date: 07/04/2014

Acceptance date: 01/01/1900

ISSN: 1462-0332

Publisher: Oxford University Press


DOI: 10.1093/rheumatology/keu114.003

Series Title: Rheumatology