PMID- 35001366 OWN - NLM STAT- MEDLINE DCOM- 20220207 LR - 20230216 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 1 IP - 1 DP - 2022 Jan 10 TI - Self-management interventions for people with chronic obstructive pulmonary disease. PG - CD002990 LID - 10.1002/14651858.CD002990.pub4 [doi] LID - CD002990 AB - BACKGROUND: Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES: Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS: We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS: We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS: Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence. CI - Copyright (c) 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Schrijver, Jade AU - Schrijver J AD - Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands. AD - Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands. FAU - Lenferink, Anke AU - Lenferink A AD - Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands. AD - Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands. FAU - Brusse-Keizer, Marjolein AU - Brusse-Keizer M AD - Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands. AD - Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands. FAU - Zwerink, Marlies AU - Zwerink M AD - Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands. FAU - van der Valk, Paul Dlpm AU - van der Valk PD AD - Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands. FAU - van der Palen, Job AU - van der Palen J AD - Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands. AD - Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands. FAU - Effing, Tanja W AU - Effing TW AD - College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia. AD - School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia. LA - eng PT - Journal Article PT - Review PT - Systematic Review DEP - 20220110 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - Cochrane Database Syst Rev. 2014 Mar 19;(3):CD002990. PMID: 24665053 MH - Aged MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - Outcome Assessment, Health Care MH - *Pulmonary Disease, Chronic Obstructive/therapy MH - Quality of Life MH - *Self-Management PMC - PMC8743569 COIS- JS: is a researcher, employed by Medisch Spectrum Twente, Enschede, the Netherlands. She received funding to complete work on this review from the Dutch Foundation for Asthma Prevention, that was in no way able to influence the results of the review. AL: is an epidemiologist and an assistant professor at the Health Technology and Services Research section, University of Twente, the Netherlands. She is also a researcher at Medisch Spectrum Twente, Enschede, the Netherlands. She coordinated the Lenferink 2019* study, included in this review. She has no conflict of interest with regard to the current review. MB-K: is an epidemiologist, employed by Medisch Spectrum Twente, Enschede, the Netherlands. She is also a researcher at the Health Technology and Services Research section, University of Twente, the Netherlands. She was involved in the study of Tabak 2014**, included in this review. She has no conflict of interest with regard to the current review. MZ: is a data-analyst and an epidemiologist, employed by Medisch Spectrum Twente, Enschede, the Netherlands. She coordinated the previous update of this review (Zwerink 2014). PvdV: is a medical doctor, pulmonologist and respiratory researcher at the Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. He was involved in the Lenferink 2019* and Tabak 2014** studies, both included in this review. He has no conflict of interest with regard to the current review. JvdP: is Professor of Evaluation and Assessment in Health Research at University of Twente, Enschede, the Netherlands. He is also an epidemiologist and research coordinator at Medisch Spectrum Twente, Enschede, the Netherlands. He was involved in the Lenferink 2019* and Tabak 2014** studies, both included in this review. He has no conflict of interest with regard to the current review. TE: is an epidemiologist affiliated with Flinders University and University of Adelaide, Adelaide, Australia. She was involved in the Lenferink 2019* study, included in this review. She has no conflict of interest with regard to the current review. * The Lenferink 2019 study was supported by the Lung Foundation Netherlands (grant number 3.4.11.061), Lung Foundation Australia (Australian Lung Foundation Boehringer Ingelheim COPD Research Fellowship 2010), Repat Foundation, GlaxoSmithKline (unrestricted grant) and Dutch Foundation for Asthma Prevention.
** The Tabak 2014 study was supported by the NL Agency, a division of the Dutch Ministry of Economic Affairs (grant CALLOP9089). EDAT- 2022/01/11 06:00 MHDA- 2022/02/08 06:00 PMCR- 2023/01/10 CRDT- 2022/01/10 06:31 PHST- 2022/01/10 06:31 [entrez] PHST- 2022/01/11 06:00 [pubmed] PHST- 2022/02/08 06:00 [medline] PHST- 2023/01/10 00:00 [pmc-release] AID - CD002990.pub4 [pii] AID - 10.1002/14651858.CD002990.pub4 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2022 Jan 10;1(1):CD002990. doi: 10.1002/14651858.CD002990.pub4.