Table 3.
Summary of the effectiveness of educational and behavioral interventions by outcomes with associated GRADE18 ratings.
| Outcome or subgroup | # Studies/participants | Treatment arms in the included studies | Outcome: intervention versus control n/N (%) | Effect estimate odds ratio (M–H, random, 95% CI); heterogeneity I2% | GRADE rating |
| SU-lowering | |||||
| SU < 5 mg/dl | 1/517 | Nurse-led education versus general practitioner care24 | 224/255 (87.8%) versus 42/262 (16%) | 37.85 [22.96, 62.40]; N/A | Moderate1 |
| SU < 6 mg/dl | 4/2825 | Pharmacist-led education and management versus usual care22
Primary care provider education versus usual care27 Pharmacist- led education and management versus usual care23 Nurse-led education versus general practitioner care24 |
644/1,365 (47.2%) versus 347/1460 (23.8%) | 4.86 [1.48, 15.97]; 97% | Moderate1 |
| Achieving at least a 2 mg/dl decrease in SU at week 26 | 1/77 | Pharmacist-led education and management versus usual care22 | 14/37 (37.8%) versus 5/40 (12.5%) | 4.26 [1.35, 13.44]; N/A | Low2 |
| ULT adherence and SU monitoring outcomes | |||||
| ULT adherent: PDC ⩾ 0.8 at 1 year | 1/1412 | Pharmacist-led education and management versus usual care23 | 300/630 (47.6%) versus 277/782 (35.4%) | 1.66 [1.34, 2.05]; N/A | Moderate1 |
| Being monitored with SU at 6 months | 1/819 | Primary care provider education versus usual care27 | 351/443 (79.2%) versus 201/376 (53.5%) | 3.32 [2.45, 4.51]; N/A | Moderate1 |
| Patients taking ULT at 6 or 24 months* | |||||
| 6 months | 1/819 | Primary care provider education versus usual care27 | 271/443 (61.2%) versus 201/376 (53.5%) | 1.37 [1.04, 1.81]; N/A | Moderate1 |
| 24 months | 1/517 | Nurse-led education versus general practitioner care24 | 247/255 (96.9%) versus 141/262 (53.8%) | 26.50 [12.58, 55.80]; N/A | Moderate1 |
| Tophi | |||||
| Presence of tophi at 2 years | 1/517 | Nurse-led education versus general practitioner care24 | 7/255 (2.75%) versus 25/262 (9.54%) | 0.27 [0.11, 0.63]; N/A | Moderate1 |
| Continuous outcomes Mean (SD): intervention versus control |
Continuous outcomes SMD (IV, random, 95% CI);
I2% |
||||
| Change in SU, mg/dl* | |||||
| Outcome or subgroup | # Studies/participants | Treatment arms in theincluded studies | Mean (SD):intervention versuscontrol | SMD (IV, random, 95% CI); I2% | GRADErating |
| 1/1412 | Pharmacist-led education and management versus usual care23 | −1.67 (1.84) versus −1.35 (1.86) | −0.17 [−0.28, −0.07]; N/A | Moderate1 | |
| 1/77 | Pharmacist-led education and management versus usual care22 |
−1.5 (0.3) versus 0.1 (0.3) | −5.28 [−6.25, −4.31]; N/A | Low2 | |
| PDC for ULT at 1 year | 1/1412 | Pharmacist-led education and management versus usual care23 | 0.66 (0.29) versus 0.59 (0.29) | 0.24 [0.14, 0.35] N/A |
Moderate1 |
| Ending dose of allopurinol, mg/day* | |||||
| 1/1412 | Pharmacist-led education and management versus usual care23 | 235 (104) versus 203 (103) | 0.31 [0.20, 0.41]; N/A | Moderate1 | |
| 1/517 | Nurse-led education versus general practitioner care24 | 470 (140) versus 240 (107) | 1.85 [1.64, 2.05]; N/A | Moderate1 | |
| Patient satisfaction visual analogue scale (0–100 mm) | 1/100 | Nurse-led education versus no education25 | 87.5 (24.5) versus 75.4 (20.3) | 0.53 [0.13, 0.93]; N/A | Low2 |
| Patient satisfaction questionnaire (scale not reported) | 1/100 | Nurse-led education versus no education25 | 4.02 (0.4) versus 3.71 (0.39) | 0.78 [0.37, 1.19]; N/A |
Low2 |
| Level of knowledge about gout (scale not reported) | 1/100 | Nurse-led education versus no education25 | 7.38 (2) versus 6.08 (2.24) | 0.61 [0.21, 1.01]; N/A | Low2 |
| Mean gout attack frequency/year during second year | 1/517 | Nurse-led education versus general practitioner care24 | 0.33 (0.93) versus 0.94 (2.03) | −0.38 [−0.56, −0.21]; N/A | Moderate1 |
| SF-36 norm-based physical component scores | 1/517 | Nurse-led education versus general practitioner care24 | 41.31 (16.76) versus 37.87 (14.31) | 0.22 [0.05, 0.39]; N/A |
Moderate1 |
SMD is same as the effect size and is defined as SMD = (mean in experimental group)−(mean in control group)/standard deviation.
Cohen’s interpretation of effect size, which is also applicable to SMD is that 0.2, 0.5 and 0.8 are considered thresholds for a small, medium and large effect sizes respectively.
Due to high heterogeneity in the combined analyses, results are presented and discussed separately for the two studies. GRADE evidence rating was moderate to low.
Level of evidence was downrated from high to moderate for the risk of bias.
Level of evidence was downrated from high to low for the risk of bias, and imprecision.
CI, confidence interval; GRADE, Grading of Recommendations, Assessment, Development, and Evaluation approach; IV, intravenous; M–H, Mantel-Haenszel test; N/A, not applicable; PDC, proportion of days covered; SD, standard deviation; SMD, standardized mean difference; SU, serum urate; ULT, urate-lowering therapy.
Heterogeneity as measured by I2 was not applicable in most instances where data were provided by only one study.