Sickle cell disease: psychological therapies have limited effects

Clinical bottom line (level 1a)

  1. Patients with sickle cell disease who receive educational interventions feel better about the healthcare they receive.
  2. Patients who receive cognitive behavioural therapy feel more confident and better able to control pain.
Anie and Green: Cochrane Library 2002; 2 : -
Expires June 2004

The study

Systematic review of all controlled clinical trials of
  • Patients: sickle cell disease
  • Intervention: psychological therapy compared with no therapy
  • Outcome: pain, mood, coping strategies, quality of life

Articles found in all languages using Cochrane Cystyic Fibrosis and Genetic Disorders Group specialist trials register (including Embase, PsycLIT, Psychoinfo, Medline, Central/CCTR), to January 2001 (search terms: ) and hand-searching relevant journals and abstract books of conference proceedings, and searching the Internet.

Selection criteria: by 2 independent reviewers
Appraisal criteria: by 2 independent reviewers using blinding, randomisation, intention-to-treat analyses, loss to follow-up, allocation concealment
Articles excluded if:
3 RCTs found involving 158 patients. 2 assessed patient education, and the other cognitive/behaviour coping skills. Studies reported results in different ways, so these could not been combined. Consequently no assessment of heterogeneity was possible.

The evidence

  • Patient educational strategies improved attitudes towards healthcare personnel (WMD -4.4: 95% CI: -6.5 to -2.3) and medication (WMD -1.7: 95% CI: -3.0 to -0.50).
  • Cognitive behavioural therapy improved confidence (weighted mean difference -15, 95% CI: -22 to -7.8) and a belief in being able to control pain (WMD -3.8 95% CI:-6.1 to -1.6), but had no clear effect on overall mental health or coping abilities.

Citation

  1. Anie KA, and Green J: psychological therapies for sickle cell disease and pain. Cochrane Library 2002; 2 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient sickle cell disease
Intervention or Exposure psychological therapies
Outcome coping strategies, mental health