A Cochrane review [Abstract] 1 included 10 studies. Nine studies were educational and predominantly parent-focused (n=2 003), and one study was a child-centred psychological intervention (n = 44). All interventions were adjuncts to conventional therapy and were delivered in primary- and secondary-care settings. Included studies provided a range of interventions, from a single 15-minute consultation to a comprehensive series of sessions delivered to groups of parents over a period of 12 hours.
Several studies using educational interventions demonstrated improvements in eczema severity and quality of life for both children and families. The largest and most robust study (n = 992) using a multi-disciplinary group education intervention in a hospital setting showed modest improvements in disease severity and quality of life, in both nurse- and dermatologist-led intervention groups. The educational programme involved group training at 6 sessions once a week for 2 hours from a multiprofessional team. For younger children (3 months to 7 years), the intervention was directed at parents; for the intermediate age range (8 to 12 years), the intervention was directed at both parents and children; and for older children (13 to 18 years), the intervention was directed at the children themselves. The intervention reduced disease severity at 12-month follow-up measured by the objective SCORAD (SCORing Atopic Dermatitis), combined over all the age groups (MD -4.30, 95% CI -2.46 to -6.14). Results by age group are shown in table T1.
| Age group | SCORAD: MD (95% CI) | P value |
|---|---|---|
| 3 months to 7 years | 4.2 (1.7 to 6.8) | 0.0009 |
| 8 to 12 years | 6.7 (2.1 to 11.2) | 0.005 |
| 13 to 18 years | 9.9 (4.3 to 15.5) | <0.0001 |
In 3 of 5 studies, which could not be combined because of their heterogeneity, the objective SCORAD measure was statistically significantly better in the intervention group compared with the usual care groups. However, in all of the above studies, the confidence interval limits did not exceed the minimum clinically important difference of 8.2 for objective SCORAD.
The largest study measured quality of life using the German 'Quality of life in parents of children with atopic dermatitis' questionnaire, a validated tool with 5 subscales. Parents of children under 7 years had significantly better improvements in the intervention group on all 5 subscales. Parents of children aged 8 to 12 years experienced significantly better improvements in the intervention group on 3 of the 5 subscales.
The single psychological study identified significant differences in 2 of 3 elements of the multi-dimensional clinical severity score (surface damage and lichenification) between the intervention groups (biofeedback and hypnotherapy) and the control group (discussion only).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), and by inconsistency (variability in results).
Primary/Secondary Keywords