posted on 2016-05-18, 11:10authored byK. Jolly, S. Majothi, A. J. Sitch, N. R. Heneghan, R. D. Riley, D. J. Moore, E. J. Bates, A. M. Turner, S. E. Bayliss, M. J . Price, Sally J. Singh, P. Adab, D. A. Fitzmaurice, R. E. Jordan
Purpose: This systematic review aimed to identify the most effective components of interventions to facilitate self-management of health care behaviors for patients with COPD. PROSPERO registration number CRD42011001588.
Methods: We used standard review methods with a systematic search to May 2012 for randomized controlled trials of self-management interventions reporting hospital admissions or health-related quality of life (HRQoL). Mean differences (MD), hazard ratios, and 95% confidence intervals (CIs) were calculated and pooled using random-effects meta-analyses. Effects among different subgroups of interventions were explored including single/multiple components and multicomponent interventions with/without exercise.
Results: One hundred and seventy-three randomized controlled trials were identified. Self-management interventions had a minimal effect on hospital admission rates. Multicomponent interventions improved HRQoL (studies with follow-up >6 months St George’s Respiratory Questionnaire (MD 2.40, 95% CI 0.75–4.04, I2 57.9). Exercise was an effective individual component (St George’s Respiratory Questionnaire at 3 months MD 4.87, 95% CI 3.96–5.79, I2 0%).
Conclusion: While many self-management interventions increased HRQoL, little effect was seen on hospital admissions. More trials should report admissions and follow-up participants beyond the end of the intervention.
Funding
AMT reports grants from University of Birmingham/
National Institute for Health Research (NIHR), during the
conduct of the study; REJ was in receipt of an NIHR postdoctoral
research fellowship (pdf/01/2008/023) during the
conduct of the study; KJ, DAF, REJ, PA, and SJS are investigators
on an NIHR SPCR funded trial of self-management
for COPD; SJS reports that the University Hospitals of
Leicester National Health Service trust holds the IP for
a self-management manual for COPD. REJ was funded
by NIHR Health Technology Assessment Programme
(10/44/01). KJ is part-funded by the National Institute
for Health Research (NIHR) Collaborations for Leadership
in Applied Health Research and Care (CLAHRC)
West Midlands. SJS is part-funded by the CLAHRC-East
Midlands. Malcolm Price was supported by funding from
a multivariate meta-analysis grant from the MRC Methodology
Research Programme (grant reference number: MR/
J013595/1).