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Cited by 572Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesNursing care and research

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Self management for patients with chronic obstructive pulmonary disease

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Zwerink, Marlies, Brusse-Keizer, Marjolein, van der Valk, Paul DLPM, Zielhuis, Gerhard A, Monninkhof, Evelyn M, van der Palen, Job, Frith, Peter A, Effing, Tanja·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002990.pub3PMC PMC7004246
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Abstract

BACKGROUND: Self management interventions help patients with chronic obstructive pulmonary disease (COPD) 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 patients to control their disease. Since the first update of this review in 2007, several studies have been published. The results of the second update are reported here. OBJECTIVES: 1. To evaluate whether self management interventions in COPD lead to improved health outcomes.2. To evaluate whether self management interventions in COPD lead to reduced healthcare utilisation. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register of trials (current to August 2011). SELECTION CRITERIA: Controlled trials (randomised and non-randomised) published after 1994, assessing the efficacy of self management interventions for individuals with COPD, were included. Interventions with fewer than two contact moments between study participants and healthcare providers were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Investigators were contacted to ask for additional information. When appropriate, study results were pooled using a random-effects model. The primary outcomes of the review were health-related quality of life (HRQoL) and number of hospital admissions. MAIN RESULTS: Twenty-nine studies were included. Twenty-three studies on 3189 participants compared self management versus usual care; six studies on 499 participants compared different components of self management on a head-to-head basis. Although we included non-randomised controlled clinical trials as well as RCTs in this review, we restricted the primary analysis to RCTs only and reported these trials in the abstract.In the 23 studies with a usual care control group, follow-up time ranged from two to 24 months. The content of the interventions was diverse. A statistically relevant effect of self management on HRQoL was found (St George's Respiratory Questionnaire (SGRQ) total score, mean difference (MD) -3.51, 95% confidence interval (CI) -5.37 to -1.65, 10 studies, 1413 participants, moderate-quality evidence). Self management also led to a lower probability of respiratory-related hospitalisation (odds ratio (OR) 0.57, 95% CI 0.43 to 0.75, nine studies, 1749 participants, moderate-quality evidence). Over one year of follow-up, eight (95% CI 5 to 14) participants with a high baseline risk of respiratory-related hospital admission needed to be treated to prevent one participant with at least one hospital admission, and 20 (95% CI 15 to 35) participants with a low baseline risk of hospitalisation needed to be treated to prevent one participant with at least one respiratory-related hospital admission.No statistically significant effect of self management on all-cause hospitalisation (OR 0.77, 95% CI 0.45 to 1.30, 6 studies, 1365 participants, low-quality evidence) or mortality (OR 0.79, 95% CI 0.58 to 1.07, 8 studies, 2134 participants, very low-quality evidence) was detected. Also, dyspnoea measured by the (modified) Medical Research Council Scale ((m)MRC) was reduced in individuals who participated in self management (MD -0.83, 95% CI -1.36 to -0.30, 3 studies, 119 participants, low-quality evidence). The difference in exercise capacity as measured by the six-minute walking test was not statistically significant (MD 33.69 m, 95% CI -9.12 to 76.50, 6 studies, 570 participants, very low-quality evidence). Subgroup analyses depending on the use of an exercise programme as part of the intervention revealed no statistically significant differences between studies with and without exercise programmes in our primary outcomes of HRQoL and respiratory-related hospital admissions.We were unable to pool head-to-head trials because of heterogeneity among interventions and controls; thus results are presented narratively within the review. AUTHORS' CONCLUSIONS: Self management interventions in patients with COPD are associated with improved health-related quality of life as measured by the SGRQ, a reduction in respiratory-related hospital admissions, and improvement in dyspnoea as measured by the (m)MRC. No statistically significant differences were found in other outcome parameters. However, heterogeneity among interventions, study populations, follow-up time and outcome measures makes it difficult to formulate clear recommendations regarding the most effective form and content of self management in COPD.

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Authors
Zwerink, M., Brusse-Keizer, M., van der Valk, P. D., Zielhuis, G. A., Monninkhof, E. M., van der Palen, J., Frith, P. A., & Effing, T.
Affiliations
  • Medisch Spectrum Twente (NL)
  • Radboud University Medical Center (NL)
  • University Medical Center Utrecht (NL)
  • Flinders University (AU)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-03-24
Issue
3
Pages
CD002990-CD002990
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002990.pub3
PMC
PMC7004246
OpenAlex
W2100389803
Cited by
572
References
0
Citations by year
2026: 11 · 2025: 13 · 2024: 27 · 2023: 30 · 2022: 40 · 2021: 50 · 2020: 69 · 2019: 59 · 2018: 73 · 2017: 87 · 2016: 62 · 2015: 32 · 2014: 17
FWCI
11.30
Type
journal article
Language
en
Update notices
new_version (2022-01-10)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • University of Twente Research Information (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
  • Health Sciences › Nursing › Research and Theory › Nursing care and research
Keywords
chronic obstructive pulmonary disease, self-management interventions, health-related quality of life, hospitalization, health care utilization, St George's Respiratory Questionnaire, COPD exacerbations, patient education, disease self-management
MeSH terms
Health Status, Hospitalization, 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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