Self-management education for patients with chronic obstructive pulmonary disease
Open accessAbstract
BACKGROUND: There is great interest in chronic obstructive pulmonary disease (COPD) and the associated large burden of disease. COPD is characterised by frequent day by day fluctuations, and repetitive clinical exacerbations are typical. Self-management is a term applied to educational programmes aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. In COPD, the value of self-management education is not yet clear. The first Cochrane review about self-management was published in 2003. It was intended to shed light on the effectiveness of self-management programmes in COPD and the relative efficacy of their constitutive elements. No conclusions about the effectiveness of self-management could be drawn because of the large variation in outcome measures used in the limited number of included studies. This article describes the first update of this review. OBJECTIVES: The objective of this review was to assess the settings, methods and efficacy of COPD self-management education programmes on health outcomes and use of health care services. SEARCH STRATEGY: We searched the Cochrane Airways Group trial register, MEDLINE (January 1985 to January 2006), reference lists, and abstracts of medical conferences. SELECTION CRITERIA: Controlled trials (randomised and non-randomised) of self-management education in patients with COPD. Studies focusing mainly on pulmonary rehabilitation and studies without usual care as a control group were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted data. Investigators were contacted for additional information. MAIN RESULTS: The reviewers included 15 group comparisons drawn from 14 trials. They assessed a broad-spectrum of interventions and health outcomes with different follow-up times. Meta-analyses could often not appropriately be performed because of heterogeneity among studies. The studies showed a significant reduction in the probability of at least one hospital admission among patients receiving self-management education compared to those receiving usual care (OR 0.64; 95% CI (0.47 to 0.89)). This translates into a one year NNT ranging from 10 (6 to 35) for patients with a 51% risk of exacerbation, to an NNT of 24 (16 to 80) for patients with a 13% risk of exacerbation. On the disease specific SGRQ, differences reached statistical significance at the 5% level on the total score (WMD -2.58; 95% CI (-5.14 to -0.02)) and impact domain (WMD -2.83; 95% CI (-5.65 to -0.02)), but these difference did not reach the clinically relevant improvement of 4 points. A small but significant reduction was detected in dyspnoea measured with the BORG-scale (WMD -0.53; 95% CI (-0.96 to -0.10)). No significant effects were found either in number of exacerbations, emergency department visits, lung function, exercise capacity, and days lost from work. Inconclusive results were observed in doctor and nurse visits, on symptoms other than dyspnoea, the use of courses of oral corticosteroids and antibiotics, and the use of rescue medication. AUTHORS' CONCLUSIONS: It is likely that self-management education is associated with a reduction in hospital admissions with no indications for detrimental effects in other outcome parameters. This would in itself already be enough reason for recommending self-management education in COPD. However, because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programmes in COPD. There is an evident need for more large RCTs with a long-term follow-up, before more conclusions can be drawn.
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Achieving the potential of primary care as a platform to effectively deliver SMS and achieve the stated outcomes means overcoming known barriers, such as limited time, skills and confidence among health professionals.
“achieving the potential of primary care as a platform to effectively deliver SMS and achieve the stated outcomes means overcoming known barriers, such as limited time, skills and confidence among health professionals [31, 147].”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [147]
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- Authors
- Effing, T., Monninkhof, E. E., van der Valk, P. P. D. L. P. M., Zielhuis, G. G., Walters, E. H., van der Palen, J. J., & Zwerink, M.
- Affiliations
- Medisch Spectrum Twente (NL)
- University of Tasmania (AU)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2007-10-17
- Issue
- 4
- Pages
- CD002990-CD002990
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W2114199224
- Cited by
- 536
- References
- 5
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 12 · 2022: 6 · 2021: 11 · 2020: 18 · 2019: 13 · 2018: 18 · 2017: 31 · 2016: 31 · 2015: 41 · 2014: 67 · 2013: 70 · 2012: 69
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2014-03-24)
- Open access
- green
- figshare.com
- Licence
- cc-by
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Keywords
- chronic obstructive pulmonary disease, self-management education, COPD exacerbations, hospitalization, health care utilization, St George's Respiratory Questionnaire, health-related quality of life, patient education, usual care
- MeSH terms
- Humans, Patient Compliance, Patient Education as Topic, Quality of Life, Self Care, Program Evaluation, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Pulmonary Disease, Chronic Obstructive
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