Self management for patients with chronic obstructive pulmonary disease

• Published in: Cochrane database of systematic reviews 2014-03, Vol.2014 (3), p.CD002990-CD002990
• Main Authors: Zwerink, Marlies, Brusse-Keizer, Marjolein, van der Valk, Paul D L P M, Zielhuis, Gerhard A, Monninkhof, Evelyn M, van der Palen, Job, Frith, Peter A, Effing, Tanja
• Format: Article
• Language: English
• Subjects: Chronic obstructive pulmonary disease, stable ‐ non‐pharmacotherapy; Health Status; Hospitalization - statistics & numerical data; Humans; Insurance medicine; Lungs & airways; Outcome Assessment, Health Care; Patient Compliance; Patient Education as Topic; Program Evaluation; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Randomized Controlled Trials as Topic; Self Care
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD002990.pub3

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. 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. We searched the Cochrane Airways Group Specialised Register of trials (current to August 2011). 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. 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. 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 pr