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Features of self-management interventions for people with chronic obstructive pulmonary disease associated with improved health-related quality of life and reduced emergency department visits: a systematic review of reviews with meta-analysis

Lookup NU author(s): Dr James Newham, Dr Justin Presseau, Dr Sian Russell, Dr Dapo Ogunbayo, Professor Barbara Hanratty, Professor Eileen Kaner

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Background: Self-management interventions (SMIs) are recommended for individuals with chronic obstructive pulmonary disease (COPD) to help monitor symptoms and optimise health-related quality of life (HRQOL). However, SMIs vary widely in content, delivery and intensity; making it unclear which methods and techniques are associated with improved outcomes. This systematic review of reviews aimed to summarise the current evidence-base surrounding the effectiveness of SMIs for improving HRQOL in people with COPD.Methods: Systematic reviews that focused upon SMIs were eligible for inclusion. Intervention descriptions were coded for behaviour change techniques that targeted self-management behaviours to address (i) symptoms, (ii) physical activity and (iii) mental health. Meta-analyses and meta-regression were used to explore the association between health behaviours targeted by SMIs, the behaviour change techniques used, patient illness severity, and modes of delivery, with the impact on HRQOL and emergency department (ED) visits. Results: Data related to SMI content were extracted from 26 randomized controlled trials identified from 11 systematic reviews. Patients receiving SMIs reported improved HRQOL (SMD=-0.16; 95% CI=-0.25, -0.07; p=0.001) and made fewer ED visits (SMD=-0.13; 95% CI=-0.23, -0.03; p=0.02) compared to patients that received usual care. Patients receiving SMIs targeting mental health alongside symptom management had greater improvement on HRQOL (Q=4.37; p=0.04) and fewer ED visits (Q=5.95; p=0.02) than patients receiving SMIs those focused on symptom management alone. Within-group analyses showed that HRQOL was significantly improved in (i) studies with COPD patients with severe symptoms, (ii) single-practitioner based SMIs but not SMIs delivered by a multi-disciplinary team, (iii) SMIs with multiple sessions but not single session SMIs, and (iv) both individual- and group-based SMIs.Conclusion: SMIs can be effective at improving HRQOL and reducing ED visits; with those targeting mental health being significantly more effective than those targeting symptom management alone.


Publication metadata

Author(s): Newham JJ, Presseau J, Heslop-Marshall K, Russell S, Ogunbayo OJ, Netts P, Hanratty B, Kaner E

Publication type: Article

Publication status: Published

Journal: International Journal of Chronic Obstructive Pulmonary Disease

Year: 2017

Volume: 12

Pages: 1705-1720

Online publication date: 08/06/2017

Acceptance date: 22/03/2017

ISSN (electronic): 1178-2005

Publisher: Dove Medical Press Ltd.

URL: https://doi.org/10.2147/COPD.S133317

DOI: 10.2147/COPD.S133317


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