Overview of Cochrane Systematic Reviews of rehabilitation interventions for persons with rheumatoid arthritis: a mapping synthesis

The aim of this paper was to provide an overview of Cochrane Systematic Reviews (CSRs), which synthesizes the quality and quantity of avail-able evidence on the effectiveness of rehabilitation interventions in rheumatoid arthritis (RA). The World Health Organization (WHO) requested Cochrane Rehabilitation the CSRs search to develop the Package of Interventions in Rehabilitation (PIR). We searched the Cochrane Library using the terms "rheumatoid arthritis" and "rehabilitation." We screened the CSRs according to the search strategy based on the methodology developed for the WHO PIR. The search period for the data provided to WHO was between 1 September 2009 and 2019. We updated the search to 1 September 2022 for this paper. We summarized the CSRs identified after the screening process using an evidence map, grouping outcomes, and comparisons of included CSRs indicating the effect and the quality of evidence to provide a comprehensive view of current knowledge. We identified 10 CSRs, including 92 primary studies with 10,801 participants and 23 comparisons. They explored the effectiveness and/or safety of either non-pharmacological or pharmacological (for symptom control only) interventions. Outcomes were pain, muscle strength, grip/pinch strength, tender joints, swollen joints, fatigue, disease activity, radiological damage, physical function, hand function, participant adherence, clinical improvement, withdrawals, and adverse events. Our mapping synthesis indicates that physical activity and exercises in RA are effective non-pharmacological interventions for some outcomes, such as hand function, muscle strength and fatigue, without any deterioration of pain, disease activity and radiological involvement. Psychosocial interventions show a small beneficial effect on fatigue. Regarding pharmacological agents, celecoxib presents similar analgesic effects with traditional NSAIDs but fewer gastric adverse events. Current evidence supports physical activity and exercise programs for individuals with RA. However, well-designed studies will help document the exact effects of these programs on different outcomes and physiological mechanisms in RA. There were inconclusive results for some of the interventions due to low and very-low quality of evidence. Furthermore, due to the lack of CSRs on therapeutic patient education, orthoses, physical modalities and assistive devices in the search period, it was impossible to synthesise the evidence on those interventions.