Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis.

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

Effectiveness of therapeutic patient education interventions for chronic diseases: A systematic review and meta-analyses of randomized controlled trials.

Background: Chronic disorders are highly prevalent and are a major contributor to death and disability worldwide. Evidence has shown that therapeutic patient education (TPE) interventions are effective in improving a range of biomedical and psychological outcomes for a variety of chronic disorders. This has been demonstrated in scores of randomized controlled and evidence-synthesis studies. However, no quantitative evidence has been published so far on the content and effective teaching strategies in TPE programs. The present systematic review and meta-analysis aim to bridge this gap by answering the who, what, and how of TPE programs. Methods: Using a pretested search strategy, we searched the Web of Science, MEDLINE, CINAHL, PsycINFO, and the COCHRANE databases, from inception to August 2019. The search strategy was based on four comprehensive search concepts (patient education, chronic diseases, study design, and outcomes). After a careful screening for eligible studies, two reviewers extracted qualitative and quantitative data from the randomized controlled trials on the TPE interventions. We also developed a taxonomy of curriculum skills and intervention delivery techniques to aid the extraction of data in these domains. Results: We found that these interventions were effective in improving biological outcomes (SMD = 0.48; 95% CI: 0.38-0.57), adherence to the treatment regimen (SMD = 0.73; 95% CI: 0.46-1.002), knowledge (SMD = 1.22; 95% CI: 0.79-1.65), self-efficacy (SMD = 0.43; 95% CI: 0.30-0.56), and psychological health (SMD = -0.41; 95% CI: -0.53 to -0.29). This effectiveness was consistent across different delivery formats (individual, group, and electronic) and delivery agents (non-specialists vs. specialists). Conclusion: The flexibility in the choice of mode of delivery and curriculum development gives stakeholders an opportunity to scale up TPE interventions in healthcare settings. Systematic review registration: Identifier: CRD42019141294.

Biofeedback training for partial weight bearing in patients after total hip arthroplasty.

OBJECTIVE: To evaluate a new biofeedback training method based on visual delivery of information in patients after total hip arthroplasty (THA). DESIGN: Intervention study with prepost design. SETTING: Hospitalized care in a university referral center. PARTICIPANTS: Patients (N=11) (age 56.1+/-9.0 y) shortly after THA. INTERVENTION: A mobile system has been used for biofeedback training with the predefined partial weight bearing (PWB) threshold of 20 kg. After the learning period, 4 retention tests, consisting of 3 successive walking cycles without feedback, were recorded for each patient: (1) acquisition test, (2) early retention test (after 30 min), (3) the day after, and (4) after 2 days. MAIN OUTCOME MEASURE: The pressure error and the maximum pressure force at each step before and after biofeedback training. RESULTS: A significant difference of pressure errors between the beginning and the end of the learning period has been measured (42.5+/-22.5 N vs 3.7+/-11.4N, P<.001). However, there was no difference between the beginning of the learning period and different retention tests (after 30 minutes, after 1 day, after 2 days). In terms of maximal pressure force, there was a difference between the beginning and the end of learning (251 N vs 195 N, P<.05). The retention tests did not show significant differences compared with the baseline values. CONCLUSIONS: THA patients were able to use the defined PWB during a short period of time and shortly after stopping the training; both the pressure errors and the maximal pressure force attended the values before training. These results confirm the difficulties to achieve PWB in patients after THA.

[Follow-up, therapeutic education, and pharmacologic treatments of patients with type 2 diabetes. Various critical views]. / Suivi, formation thérapeutique et traitements pharmacologiques des patients atteints de diabète sucré. Quelques réflexions critiques.

Several factors have to be taken into account for successful therapeutic patient education: patients' acceptance of the illness; an interactive educational process, the inclusion of therapeutic objectives in the short, medium and long-term which should be planned with the patient. There are numerous facets in the treatment of diabetes, but the common denominator is the dietary programme coupled with daily physical activity. This is the condition sine qua non to be included before the introduction of any pharmacological treatment. The benefits of this latter treatment are: 1) insulin substitution with insulin analogue responding especially quickly, thereby stopping the glycaemic level from falling; 2) insulin secretagogues (Sulfonylurea, Glinides, [Novonorm, Starlix]); 3) agents which raise the sensibility to insulin (glitazones, [Avandia], biguanides); 4) molecules which interfere with the absorption of the glucose at the digestive level (biguanides and alphaglucosidase inhibitors).

Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial.

We conducted a randomized clinical trial to assess the effectiveness of a newly established education program for adults with asthma. The program was designed to improve patients' health and functional status. Hospitalized patients with asthma were randomly assigned to immediate education or a 6-month waiting list. The education program consisted of three group sessions, delivered by trained educators, and focused on improving patients' self-management skills. Of 253 eligible patients, 131 agreed to participate (66 assigned to immediate education, 65 controls) and 115 (88%) completed the follow-up assessment at 6 months. At follow-up, most indicators of self-management skills and health and functional status had improved significantly among educated patients, but similar improvements were also seen among controls. The trial arms differed significantly on only four variables: patients in the immediate-education group were more likely to develop confidence in their asthma treatment (odds ratio adjusted for baseline [OR] = 2.9; 95% confidence interval [CI]: 1.0 to 8.1), to improve their knowledge of correct inhalation technique (OR = 2.4; 95% CI: 1.0 to 5.7), and to improve knowledge of the peak flow reading that warrants calling a physician (OR = 3.1; 95% CI: 1.4 to 6.7), but they improved less on the Asthma Quality of Life Questionnaire "activity" score (difference: -0.4 on a 1 to 7 scale; 95% CI: -0.8 to 0.0). Use of health services during follow-up was similar in the two groups. The education program did not enhance patients' health and functional status, despite improving a few self-management skills. These results underscore the need for controlled evaluations of education programs.