Self-management of health care behaviors for COPD: a systematic review and meta-analysis

Abstract

Purpose

This systematic review aimed to identify the most effective components of interventions to facilitate self-management of health care behaviors for patients with COPD. PROSPERO registration number CRD42011001588.

Methods

We used standard review methods with a systematic search to May 2012 for randomized controlled trials of self-management interventions reporting hospital admissions or health-related quality of life (HRQoL). Mean differences (MD), hazard ratios, and 95% confidence intervals (CIs) were calculated and pooled using random-effects meta-analyses. Effects among different subgroups of interventions were explored including single/multiple components and multicomponent interventions with/without exercise.

Results

One hundred and seventy-three randomized controlled trials were identified. Self-management interventions had a minimal effect on hospital admission rates. Multicomponent interventions improved HRQoL (studies with follow-up >6 months St George’s Respiratory Questionnaire (MD 2.40, 95% CI 0.75–4.04, I² 57.9). Exercise was an effective individual component (St George’s Respiratory Questionnaire at 3 months MD 4.87, 95% CI 3.96–5.79, I² 0%).

Conclusion

While many self-management interventions increased HRQoL, little effect was seen on hospital admissions. More trials should report admissions and follow-up participants beyond the end of the intervention.

Keywords:

• COPD
• self-management
• systematic review
• meta-analysis

Supplementary materials

Figure S1 HRQoL (SGRQ) at final follow-up for comparisons assessing the effects of one additional component of self-management.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire; Int, intervention group; Cont, control group.

Figure S2 HRQoL (CRQ) at final follow-up for comparisons assessing the effects of one additional component of self-management.

Note: D = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs modern rehabilitation + breathing training + limb training.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; CRQ, Chronic Respiratory disease Questionnaire.

Figure S3 HRQoL (SGRQ) outcomes for exercise-only interventions versus usual care/sham intervention.

Note: *The control group that has been halved in size (split between two comparisons). A = t’ai chi qigong vs control. B = exercise vs control.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.

Figure S4 Hospital admissions for multicomponent self-management interventions versus usual care.

Notes: B = exercise vs control. ^Several papers are represented by this lead publication.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HR, hazard ratio.

Figure S5 HRQoL (CRQ) outcomes for multicomponent self-management intervention versus usual care.

Note: A = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs UC.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; CRQ, Chronic Respiratory disease Questionnaire; UC, usual care.

Figure S6 HRQoL (SGRQ) outcomes for multicomponent self-management interventions including supervised exercise versus usual care/control.

Notes: B = exercise vs control. ^Several papers are represented by this lead publication.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.

Figure S7 HRQoL (CRQ) outcomes for multicomponent self-management interventions including supervised exercise versus usual care/control.

Note: A = rehabilitation (traditional and modern) + qigong + breathing training + limb training vs UC.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; CRQ, Chronic Respiratory disease Questionnaire; UC, usual care.

Figure S8 HRQoL (SGRQ) outcomes for multicomponent self-management interventions with structured, unsupervised exercise versus usual care/control.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.

Figure S9 HRQoL (SGRQ) outcomes for multicomponent self-management interventions with exercise counseling only versus usual care/control.

Note: ^Several papers are represented by this lead publication.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire.

Figure S10 HRQoL (SGRQ) outcomes for multicomponent self-management interventions without an exercise element versus usual care/control.

Notes: *The control group that has been halved in size (split between two comparisons). A = nurse-assisted collaborative management vs UC; B = nurse-assisted medical management vs UC.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; HRQoL, health-related quality of life; SGRQ, St George’s respiratory questionnaire; UC, usual care.

Table S1 Definitions of components of self-management

Table S2 Content of interventions by the number of components within the self-management package

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Acknowledgments

The authors thank Simon Stevens for his administrative support. All the people who kindly gave their time to help translate articles are as follows: Yumiko Akiya, Dom Barkos, Susan Bayliss, Matthew Blackburn, Yumi Chen, Jennifer Choi, Karin Diaconu, Janine Dretzke, Maxwell Feltham, Ditte Hedegaard, Boris Kysela, Antje Lindenmeyer, Kinga Malottki, Cristina Peñaloza, and Amanda Zhang.

Disclosure

AMT reports grants from University of Birmingham/National Institute for Health Research (NIHR), during the conduct of the study; REJ was in receipt of an NIHR postdoctoral research fellowship (pdf/01/2008/023) during the conduct of the study; KJ, DAF, REJ, PA, and SJS are investigators on an NIHR SPCR funded trial of self-management for COPD; SJS reports that the University Hospitals of Leicester National Health Service trust holds the IP for a self-management manual for COPD. REJ was funded by NIHR Health Technology Assessment Programme (10/44/01). KJ is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. SJS is part-funded by the CLAHRC-East Midlands. Malcolm Price was supported by funding from a multivariate meta-analysis grant from the MRC Methodology Research Programme (grant reference number: MR/J013595/1). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment programme, NIHR, National Health Service, or the Department of Health. Any errors are the responsibility of the authors. The other authors report no other conflicts of interest in this work.

Author contributions

KJ and REJ conceived the study, KJ, REJ, RDR, PA, DAF, and DJM contributed to the protocol, SEB advised on and performed search strategies, KJ, SM, REJ, NRH, DJM, PA, and AMT contributed to study selection, SM led the development of a risk of bias and data extraction tools, SM, NRH, and EJB extracted results, SM, EJB, NRH, DJM, and KJ undertook the risk of bias assessment, SM, MJP, and RDR coordinated and undertook some data extraction and/or calculation of effect estimates, RDR advised on statistical and reviewing methods and supervised statistical analyses, AJS undertook the statistical analyses, KJ oversaw the analyses, SJS, DAF, and AMT provided clinical input, KJ with input from REJ and RDR wrote and edited the paper. All authors contributed to the paper and commented on the final version.