Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus
Open accessAbstract
Background: Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. Methods: A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. Results: Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. Conclusions: Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Nonpharmacological interventions delivered remotely and in person have shown promise to improve QoL and psychological outcomes in patients with lupus.
“Nonpharmacological interventions (eg, psychological, educational interventions) delivered remotely and in person have shown promise to improve QoL and psychological outcomes in patients with lupus (5).”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Rayyan-a web and mobile app for systematic reviews.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016) · Systematic Reviews · doi:10.1186/s13643-016-0384-4 · Cited by 26,092 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., et al. (2016) · BMJ · doi:10.1136/bmj.i4919 · Cited by 20,329 · see citing works
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,759 · see citing works
The rand 36‐item health survey 1.0
Hays, R. D., Sherbourne, C. D., & Mazel, R. M. (1993) · Health Economics · doi:10.1002/hec.4730020305 · Cited by 2,893 · see citing works
Weckerle, C. E., & Niewold, T. (2011) · Clinical reviews in allergy and immunology · doi:10.1007/s12016-009-8192-4 · Cited by 286 · see citing works
Leong, K. P., Kong, K. O., Thong, B. Y., Koh, E. T., Lian, T. Y., Teh, C. L., Cheng, Y. K., Chng, H. H., Badsha, H., Law, W. G., et al. (2005) · Rheumatology · doi:10.1093/rheumatology/keh605 · Cited by 205 · see citing works
Fatigue in systemic lupus erythematosus: a randomized controlled trial of exercise
Tench, C. M. (2003) · British journal of rheumatology · doi:10.1093/rheumatology/keg289 · Cited by 200 · see citing works
Karlson, E. W., Liang, M. H., Eaton, H. M., Huang, J., Fitzgerald, L. M., Rogers, M. P., & Daltroy, L. H. (2004) · Arthritis & Rheumatism · doi:10.1002/art.20279 · Cited by 175 · see citing works
O’Dwyer, T., Durcan, L., & Wilson, F. (2017) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2017.04.003 · Cited by 151 · see citing works
Greco, C. M., Rudy, T. E., & Manzi, S. (2004) · Arthritis Care & Research · doi:10.1002/art.20533 · Cited by 150 · see citing works
[Systemic lupus erythematosus].
Pedrin, M. A. L. (2006) · PubMed · Cited by 143 · see citing works
Depression and anxiety in systemic lupus erythematosus
Figueiredo‐Braga, M., Cornaby, C., Cortez, A., Bernardes, M., Terroso, G., Figueiredo, M., Mesquita, C. D. S., Costa, L., & Poole, B. D. (2018) · Medicine · doi:10.1097/md.0000000000011376 · Cited by 142 · see citing works
de Carvalho, M. R. P., Sato, E. I., Tebexreni, A. S., Heidecher, R. T. C., Schenkman, S., & Neto, T. L. B. (2005) · Arthritis Care & Research · doi:10.1002/art.21605 · Cited by 139 · see citing works
EFFECTS OF AEROBIC CONDITIONING IN LUPUS FATIGUE: A PILOT STUDY
ROBB-NICHOLSON, L. C., Daltroy, L. H., Eaton, H. M., Gall, V., WRIGHT, E., Hartley, L. H., Schur, P. H., & Liang, M. H. (1989) · Lara D. Veeken · doi:10.1093/rheumatology/28.6.500 · Cited by 138 · see citing works
McElhone, K., Abbott, J., Gray, J., Williams, A., & Teh, L. (2010) · Lupus · doi:10.1177/0961203310378668 · Cited by 126 · see citing works
Quality of life in systemic lupus erythematosus and its measurement
Saletra, A., & Olesińska, M. (2018) · Reumatologia/Rheumatology · doi:10.5114/reum.2018.74750 · Cited by 112 · see citing works
Daltroy, L. H., Robb-Nicholson, C., Iversen, M. D., WRIGHT, E. A., & Liang, M. H. (1995) · Lara D. Veeken · doi:10.1093/rheumatology/34.11.1064 · Cited by 111 · see citing works
Impact of systemic lupus erythematosus on health, family, and work: The patient perspective
Robinson, D., Aguilar, D., Schoenwetter, M., Dubois, R. W., Russak, S. M., Ramsey‐Goldman, R., Navarra, S., Hsu, B. L., Revicki, D. A., Cella, D. F., et al. (2010) · Arthritis Care & Research · doi:10.1002/acr.20077 · Cited by 106 · see citing works
Kozora, E., Ellison, M. C., Waxmonsky, J. A., Wamboldt, F., & Patterson, T. L. (2005) · Lupus · doi:10.1191/0961203305lu2094oa · Cited by 105 · see citing works
Arriens, C., Hynan, L. S., Lerman, R. H., Karp, D. R., & Mohan, C. (2015) · Nutrition Journal · doi:10.1186/s12937-015-0068-2 · Cited by 103 · see citing works
Navarrete‐Navarrete, N., Peralta‐Ramírez, M. I., Sabio-Sánchez, J. M., Coín, M. A., Robles‐Ortega, H., Hidalgo-Tenorio, C., Ortego‐Centeno, N., Callejas-Rubio, J. L., & Jiménez-Alonso, J. F. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000276370 · Cited by 95 · see citing works
Experimental therapeutics for digital mental health.
Graham, A. K., Lattie, E. G., & Mohr, D. C. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.2075 · Cited by 93 · see citing works
Self-citationLong-term complications of systemic lupus erythematosus
Gordon, C. (2002) · British journal of rheumatology · doi:10.1093/rheumatology/41.10.1095 · Cited by 83 · see citing works
Effects of a self‐management course for patients with systemic lupus erythematosus
Sohng, K. Y. (2003) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2003.02647.x · Cited by 82 · see citing works
Gergianaki, I., & Bertsias, G. K. (2018) · Frontiers in Medicine · doi:10.3389/fmed.2018.00161 · Cited by 71 · see citing works
Non-pharmacologic therapies for systemic lupus erythematosus
Fangtham, M., Kasturi, S., Bannuru, R. R., Nash, J. L., & Wang, C. (2019) · Lupus · doi:10.1177/0961203319841435 · Cited by 71 · see citing works
Abrahão, M., Gomiero, A. B., Peccin, M. S., Grande, A. J., & Trevisani, V. F. M. (2015) · Scandinavian Journal of Rheumatology · doi:10.3109/03009742.2015.1094126 · Cited by 65 · see citing works
Dobkin, P. L., Costa, D. D., Joseph, L., Fortin, P. R., Edworthy, S. M., Barr, S. G., Ensworth, S., Esdaile, J. M., Beaulieu, A. D., Zummer, M., et al. (2002) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm2402_05 · Cited by 63 · see citing works
Bogdanovic, G., Stojanovich, L., Djoković, A., & Stanisavljević, N. (2015) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.237.193 · Cited by 62 · see citing works
Psychosocial dimensions of SLE: implications for the health care team
Beckerman, Auerbach, & Blanco (2011) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s19303 · Cited by 61 · see citing works
Maisiak, R., Austin, J. S., West, S., & Heck, L. W. (1996) · Arthritis & Rheumatism · doi:10.1002/art.1790090111 · Cited by 61 · see citing works
Boström, C., Elfving, B., Dupre, B. J., Opava, C. H., Lundberg, I. E., & Jansson, E. (2016) · Lupus · doi:10.1177/0961203315622817 · Cited by 59 · see citing works
Group psychotherapy reduces illness intrusiveness in systemic lupus erythematosus.
Edworthy, S. M., Dobkin, P. L., Clarke, A. E., Costa, D. D., Dritsa, M., Fortin, P. R., Barr, S. G., Ensworth, S., Esdaile, J. M., Beaulieu, A. D., et al. (2003) · PubMed · Cited by 58 · see citing works
A biopsychosocial model of disability in rheumatoid arthritis
Schoenfeld-Smith, K., Petroski, G. F., Hewett, J. E., Johnson, J. C., Wright, G. E., Smarr, K. L., Walker, S. E., & Parker, J. C. (1996) · Arthritis & Rheumatism · doi:10.1002/1529-0131(199610)9:5 · Cited by 54 · see citing works
Navarrete‐Navarrete, N., Peralta‐Ramírez, M. I., Sabio, J. M., Martínez-Egea, I., Santos‐Ruiz, A., & Jiménez-Alonso, J. F. (2010) · Lupus · doi:10.1177/0961203310378413 · Cited by 53 · see citing works
Conceição, C. T. M., Meinão, I. M., Bombana, J. A., & Sato, E. I. (2019) · Revista Brasileira de Reumatologia · doi:10.1186/s42358-019-0047-y · Cited by 52 · see citing works
Elefante, E., Tani, C., Stagnaro, C., Ferro, F., Parma, A., Carli, L., Signorini, V., Zucchi, D., Peta, U., Santoni, A., et al. (2020) · RMD Open · doi:10.1136/rmdopen-2019-001133 · Cited by 51 · see citing works
Quality of Life in Systemic Lupus Erythematosus
Panopalis, P., & Clarke, A. E. (2006) · Journal of Immunology Research · doi:10.1080/17402520600877760 · Cited by 49 · see citing works
Solati, K., Mousavi, M., Kheiri, S., & Dehkordi, A. H. (2017) · Oman Medical Journal · doi:10.5001/omj.2017.73 · Cited by 48 · see citing works
Mobile health technologies for the management of systemic lupus erythematosus: a systematic review
Dantas, L. O., Weber, S., Osani, M. C., Bannuru, R. R., McAlindon, T. E., & Kasturi, S. (2020) · Lupus · doi:10.1177/0961203319897139 · Cited by 48 · see citing works
Mental Health Status in Systemic Lupus Erythematosus
Omdal, R., Husby, G., & Mellgren, S. I. (1995) · Scandinavian Journal of Rheumatology · doi:10.3109/03009749509099302 · Cited by 39 · see citing works
Azizoddin, D. R., Weinberg, S., Gandhi, N., Arora, S. K., Block, J. A., Sequeira, W., & Jolly, M. (2017) · Lupus · doi:10.1177/0961203317739128 · Cited by 36 · see citing works
Shah, M., Kavanaugh, A., Coyle, Y. M., ADAMS-HUET, B. A., & Lipsky, P. E. (2002) · PubMed · Cited by 31 · see citing works
Body Image Intervention to Improve Health Outcomes in Lupus
Jolly, M., Peters, K. F., Mikolaitis, R. A., Evans-Raoul, K., & Block, J. A. (2014) · JCR Journal of Clinical Rheumatology · doi:10.1097/rhu.0000000000000141 · Cited by 30 · see citing works
Wu, M., Tsai, J., Yu, K., & Chen, J. J. (2019) · International Journal of Nursing Practice · doi:10.1111/ijn.12770 · Cited by 25 · see citing works
Ra, J. H., Leung, J., Baker, E. A., & Kim, A. H. J. (2020) · Arthritis Care & Research · doi:10.1002/acr.24399 · Cited by 19 · see citing works
Stevens, M., Walker-Bone, K. E., Culliford, D. J., Alcacer‐Pitarch, B., Blake, A., Hopkinson, N., Teh, L., Vital, E. M. J., Edwards, C. J., Williams, A. E., et al. (2019) · Journal of Foot and Ankle Research · doi:10.1186/s13047-019-0335-0 · Cited by 15 · see citing works
Sahebari, M., Ebrahimabad, M. J. A., Shoraketokanlo, A. A., Sharbaf, H. A., & Khodashahi, M. (2019) · Iranian Journal of Psychiatry · doi:10.18502/ijps.v14i2.992 · Cited by 13 · see citing works
Elsharawy, M., Hasan, M. A., Abdul‐Rahman, I. S., Al-Dhofairy, B., & Elsaid, A. S. (2015) · Avicenna Journal of Medicine · doi:10.4103/2231-0770.154197 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lu, M., & Koo, M. (2021) · Healthcare · doi:10.3390/healthcare9091215 · Cited by 22 · see citing works
Sakr, B. R., Seif, E. M., Kamel, R. M., & Eleishi, H. H. (2022) · The Egyptian Rheumatologist · doi:10.1016/j.ejr.2022.04.001 · Cited by 9 · see citing works
Mundell, A., Amarnani, R., Ainsworth, K., Chiwah, F., Hadjidemetriou, M., Katti, S., Mundell, N., Lester, C., & Metsios, G. S. (2024) · Journal of Science in Sport and Exercise · doi:10.1007/s42978-024-00303-x · Cited by 7 · see citing works
Sloan, M. A., Pollak, T. A., Massou, E., Leschziner, G. D., Andréoli, L., Harwood, R., Bosley, M., Pitkänen, M., Diment, W., Bortoluzzi, A., et al. (2024) · Lara D. Veeken · doi:10.1093/rheumatology/keae194 · Cited by 6 · see citing works
McCormick, E. M., Englund, T. R., Cleveland, R. J., Dickson, T. A., Schiller, C. E., & Sheikh, S. Z. (2022) · ACR Open Rheumatology · doi:10.1002/acr2.11433 · Cited by 5 · see citing works
Silva-Ribeiro, S., Godinho, C. I. A., Camilo, C., Marques, M. M., Chisari, C., Segura, Ú., & Bernardes, S. F. (2025) · Health Psychology Review · doi:10.1080/17437199.2025.2478877 · Cited by 5 · see citing works
Lu, M., Liu, M., Zhan, K., Chen, Y., & Liu, X. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1433868 · Cited by 4 · see citing works
Digital Psychological Intervention for Inflammatory Rheumatic Diseases
Knitza, J., Kraus, J., Krusche, M., Haase, I., Klemm, P., Hueber, A. J., Pfeil, A., Drott, U., Kühn, S., & Klein, J. P. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.29892 · Cited by 3 · see citing works
Sloan, M., Pollak, T. A., D’Cruz, D. P., Diment, W., Bosley, M., Lever, E., Mann, F., Sloan, B., Brimicombe, J. D., Stephen Morris, A., et al. (2025) · Rheumatology International · doi:10.1007/s00296-025-05959-4 · Cited by 3 · see citing works
Ratanasiripong, N. T., Cahill, S., Crane, C., & Ratanasiripong, P. (2023) · Journal of Preventive Medicine and Public Health · doi:10.3961/jpmph.22.491 · Cited by 3 · see citing works
Summary of best evidence on self-management in adult patients with systemic lupus erythematosus
Chen, J., Chen, J., Huang, Z., Chen, X., & Sun, E. (2025) · Lupus · doi:10.1177/09612033251325687 · Cited by 2 · see citing works
Harper, A. E., Chen, Y. T., Tancer, S., Rodgers, K. R., Crumb, A. D., Townsend, W. A., Knight, J. S., & Murphy, S. L. (2023) · Lupus · doi:10.1177/09612033231223336 · Cited by 2 · see citing works
Jahrestagung der Österreichischen Gesellschaft für Rheumatologie & Rehabilitation
(2022) · Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen · doi:10.1007/s41970-022-00205-w
Sun, Y., Wang, F., & Zhao, M. (2024) · Research Square · doi:10.21203/rs.3.rs-4509580/v1
Complementary and integrative medicine and women’s health
Edwards, E., Belfer, I., Kelly, B., Sekai, C., & Jean‐Francois, B. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45863-7.00005-6
From Offline Happiness to Online Fulfilment
Patil, D. S., & Singh, A. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-8357-6.ch004
- Authors
- Chang, A., Winquist, N. W., Wescott, A. B., Lattie, E. G., & Graham, A. K.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Graham, Andrea K
- Venue
- Lupus
- Publisher
- SAGE Publications
- Published
- 2021-03-28
- Volume
- 30
- Issue
- 7
- Pages
- 1058-1077
- ISSN
- 0961-2033 (ISSN-L)
- 1477-0962
- PMC
- PMC8122052
- OpenAlex
- W3143752619
- Cited by
- 16
- References
- 53
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Lupus (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K01 DK116925, K08 MH112878)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pathology and Forensic Medicine › Systemic Sclerosis and Related Diseases
- Keywords
- systemic lupus erythematosus, non-pharmacological treatment, quality of life, psychological outcomes, digital interventions, remote intervention, diet, physical activity, psychological intervention, risk of bias
- MeSH terms
- Self-Management, Psychosocial Intervention, Adult, Aged, Diet Therapy, Female, Humans, Lupus Erythematosus, Systemic, Male, Middle Aged, Quality of Life, Exercise, Comorbidity, Randomized Controlled Trials as Topic, Treatment Outcome, Outcome Assessment, Health Care, Non-Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
