Co-designing interventions for patients with inflammatory arthritis: a systematic review

BACKGROUND: Co-designing interventions for patients with inflammatory arthritis (IA) can help optimise healthcare delivery and improve patient engagement in their care. We conducted a systematic review of co-designed interventions for people living with IA. We assessed the following: (a) Intervention effectiveness, (b) the co-design phases used, and (c) barriers and enablers to conducting a co-design study. METHODS: We searched MEDLINE, Embase, CINAHL, and Science Citation Index (Web of Science) in October 2022, with an updated search conducted in March 2024. All study designs were eligible for inclusion. Experimental studies were quality assessed using the Cochrane risk-of-bias tool (RoB 2 and ROBINS-I). The study is reported according to the PRISMA guidelines. RESULTS: We screened 11,091 reports, and 22 met the eligibility criteria. A range of co-designed interventions was identified, such as patient decision-making tools, applications for monitoring clinical and patient-reported outcomes, rehabilitation, and educational interventions. There was a paucity of psychosocial support interventions. All projects involved several stages of intervention development, including needs assessment, ideation, prototyping, and evaluation. Fifteen projects conducted pilot testing of their interventions, mainly assessing usability, feasibility, and acceptability metrics. Common barriers to co-design included poor communication, issues with stakeholder representativeness, and resource constraints. Key enablers of successful co-design were iterative rounds of prototyping and feedback, engagement of diverse stakeholders, and utilisation of varied and flexible methods. CONCLUSION: Co-design is an adaptable approach for developing IA interventions and improving usability and feasibility through iterative, broad stakeholder engagement. However, its clinical effectiveness remains unproven, and common co-design barriers, such as communication challenges and limited stakeholder diversity persist. There is a need for more work on co-designed psychosocial support tools. Future work should also focus on establishing the clinical effectiveness of co-designed interventions to justify their continued development and implementation in IA care.