Educational interventions during the hospitalisation of patients with chronic respiratory disease: A systematic...

Background: Therapeutic education encompasses cognitive, psychomotor, emotional, and educational components, and is considered a fundamental tool in the management of chronic respiratory diseases. Its implementation during hospitalisation has been shown to have a positive impact on inhalation technique, patients' perceived sense of control, and the reduction of inappropriate use of healthcare resources. However, health interventions involving therapeutic education are mainly integrated within primary care, with hospital-based activity often limited to episodes of exacerbation or acute illness. Objective: The aim of this study was to synthesise the evidence on the effectiveness of educational interventions delivered during the hospital stay of adult patients with chronic respiratory disease. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using the GRADE methodology to assess the quality of evidence for each outcome analysed, as well as the Revised Cochrane risk-of-bias tool for randomised trials to evaluate the methodological quality and risk of bias. Results: Eleven studies, comprising a total of 1,925 participants, were included. Interventions encompassed educational programmes, motivational interviews, physical training plans, specific inhalation technique training, video interventions, and mobile apps for self-management. Thirteen clinical and patient-reported outcomes were analysed, with contradictory findings; consistently positive effects were observed only for quality of life. According to the GRADE methodology, all outcomes were supported by low or very low quality of evidence due to methodological limitations of the included studies, including risk of bias related to lack of blinding in educational interventions, small sample sizes, heterogeneity in intervention design and outcome measurement, and imprecision of effect estimates. Conclusion: Educational interventions conducted during hospitalisation for patients with chronic respiratory disease are limited and demonstrate a low or very low quality of evidence for all evaluated outcomes. It is imperative to design research studies that minimise the risks of bias and identify activities that can improve outcomes. Registration: PROSPERO identifier number CRD42022358094; https://www.crd.york.ac.uk/ registered 19/09/2022.