title: Effectiveness of therapeutic patient education for adults with migraine. A systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Our aim was to systematically review and meta-analyze the effectiveness of therapeutic patient education for migraine.
  
  
  METHODS
  A literature search of multiple electronic databases (MEDLINE, EMBASE, PEDro, CINAHL, and PsychINFO) was conducted to identify randomized control trials (RCTs) published in the English and Spanish languages up to and including May 2013. Two reviewers independently selected the studies, conducted the quality assessment (Delphi list), and extracted the results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used throughout the systematic review and meta-analysis. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for relevant outcome measures (headache frequency, headache disability, self-efficacy, depressive symptoms, and quality of life) and pooled in a meta-analysis using the random effects model.
  
  
  RESULTS
  Fourteen RCTs were included in the systematic review. Only nine studies were included in the meta-analysis. The median quality score was 6.14 ± 1.29 (range: 5-9). There was strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education on headache frequency (five studies: N = 940, SMD = -0.24, 95% CI of -0.48 to -0.01, P = 0.03), headache disability (four studies: N = 799, SMD = -1.02, 95% CI of -1.95 to -0.08, P = 0.03), and quality of life (three studies: N = 674, SMD = 0.36, 95% CI of 0.05-0.67, P = 0.02). There was no evidence for either short-term or intermediate-term effectiveness of therapeutic patient education on self-efficacy or depressive symptoms.
  
  
  CONCLUSIONS
  This systematic review revealed strong-moderate evidence for intermediate-term effectiveness of therapeutic patient education for migraine. Further high-quality RCTs are required for conclusive determination of its effectiveness.
authors.affiliation: Department of Physiotherapy, Faculty of Health Science, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Research Group on Movement and Behavioral Science and Study of Pain, The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Kindelan-Calvo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gil-Martínez
authors.forename: Alba
authors.initials: A
authors.lastname: Paris-Alemany
authors.forename: Joaquín
authors.initials: J
authors.lastname: Pardo-Montero
authors.forename: Daniel
authors.initials: D
authors.lastname: Muñoz-García
authors.forename: Santiago
authors.initials: S
authors.lastname: Angulo-Díaz-Parreño
authors.forename: Roy
authors.initials: R
authors.lastname: La Touche
mesh_terms: D000223:Adaptation, Psychological; D000700:Analgesics / Q000627:therapeutic use; D001521:Behavior Therapy; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D003376:Counseling; D003863:Depression / Q000209:etiology / Q000628:therapy; D004185:Disability Evaluation; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D010353:Patient Education as Topic / Q000379:methods; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012107:Research Design; D020377:Self Efficacy; D013664:Teaching Materials; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Behavioral Treatment; Headache Disability; Headache Frequency; Meta-Analysis; Migraine; Systematic Review; Therapeutic Education