Department of Dermatology, Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, Nantes, France.
Departments of Dermatology, Nantes Université, CHU Nantes, Nantes, France.
Br J Dermatol. 2024 Jul 16;191(2):177-186. doi: 10.1093/bjd/ljae111.
BACKGROUND: Therapeutic patient education (TPE) is recommended for children with atopic dermatitis (AD), but no consensus has been reached on the optimal tailoring of delivery. While repeated multidisciplinary group education sessions have shown effectiveness, the benefits of one-on-one educational interventions led by nurses for children with AD have not yet been assessed. OBJECTIVES: To assess the benefits of additional, well-structured, 1-h nurse-led individual TPE interventions in children with AD and their families compared with standard care alone. METHODS: Children with moderate-to-severe AD and their parents were randomized to receive a 1-h nurse-led education session in addition to standard care vs. standard care alone. The primary outcome was the area under the curve (AUC) of the SCORing of Atopic Dermatitis index (SCORAD) from baseline to week 24 (lower AUC values represent better long-term control of the disease). RESULTS: In our study, 176 patients were randomized across 11 centres, and 153 were included in the full analysis set. The mean (SD) age was 4.47 (4.57) years. By week 24, there were no significant differences in the AUCs of the SCORAD between the two groups (P = 0.3). Secondary outcomes including patient-reported severity and quality of life [AUCs of the patient-oriented SCORAD (PO-SCORAD) and Infants' Dermatitis Quality of Life Index (IDLQI), Children's Dermatitis Quality of Life Index (CDLQI) and Family Dermatitis Quality of Life Index (FDLQI)] were not significantly different between the two groups. The only significant change observed in the intervention group, when compared with the one receiving standard care, was a decrease in topical steroid phobia, as assessed by the topical corticosteroid phobia (TOPICOP) score. Prespecified subgroup analyses showed that disease severity in the intervention group was significantly lower throughout the study, compared with the standard-care group when participants had moderate AD at baseline (n = 47); while participants with severe AD at baseline (n = 106) did not show benefit from the intervention. Participants showed no additional benefit from the intervention regardless of age group. CONCLUSIONS: This study did not show any additional effectiveness, in long-term severity control, of a 1-h nurse-led TPE intervention in children with AD treated with standard care, compared with those treated with standard care alone. However, it should be noted that the intervention reduced the fear of using topical steroids and may be beneficial for patients in the subgroup with moderate AD.
背景： 对于特应性皮炎（AD）患儿，推荐进行治疗性患者教育（TPE），但尚未就最佳传递方式达成共识。虽然重复的多学科小组教育课程已显示出有效性，但尚未评估由护士针对 AD 患儿进行一对一教育干预的益处。
目的： 评估与单独接受标准护理相比，对 AD 患儿及其家庭进行额外的、精心设计的、1 小时的护士主导的 TPE 干预的益处。
方法： 将中重度 AD 患儿及其父母随机分配，接受 1 小时护士主导的教育课程，外加标准护理，或仅接受标准护理。主要结局为从基线到 24 周时 SCORing of Atopic Dermatitis 指数（SCORAD）的曲线下面积（AUC）（AUC 值越低表示疾病的长期控制越好）。
结果： 在我们的研究中，11 个中心共随机分配了 176 名患者，153 名患者纳入全分析集。平均（SD）年龄为 4.47（4.57）岁。到 24 周时，两组之间 SCORAD 的 AUC 没有显著差异（P = 0.3）。次要结局包括患者报告的严重程度和生活质量[患者为中心的 SCORAD（PO-SCORAD）和婴儿皮炎生活质量指数（IDLQI）、儿童皮炎生活质量指数（CDLQI）和家庭皮炎生活质量指数（FDLQI）的 AUC]在两组之间没有显著差异。与接受标准护理的组相比，干预组唯一观察到的显著变化是通过 TOPICOP 评分评估的外用皮质类固醇恐惧症的降低。预先指定的亚组分析显示，与标准护理组相比，在基线时患有中度 AD 的患者（n = 47）中，干预组的疾病严重程度在整个研究期间均显著降低；而基线时患有重度 AD 的患者（n = 106）则没有从干预中获益。无论年龄组如何，患者均未从干预中获得额外益处。
结论： 与单独接受标准护理相比，在接受标准护理的 AD 患儿中，与单独接受标准护理相比，1 小时护士主导的 TPE 干预在长期疾病严重程度控制方面没有显示出任何额外的效果。然而，应该注意的是，该干预措施降低了使用外用皮质类固醇的恐惧，可能对 AD 中度亚组患者有益。
Cochrane Database Syst Rev. 2021-4-19
Cochrane Database Syst Rev. 2017-12-22
Cochrane Database Syst Rev. 2018-4-18
Health Technol Assess. 2001
Health Technol Assess. 2024-10
Cochrane Database Syst Rev. 2017-10-3
Cochrane Database Syst Rev. 2017-5-23
Cochrane Database Syst Rev. 2017-8-4
Zotero 插件