Counseling for health behavior change in people with COPD: systematic review

Figures & data

Table 1 Summary of RCTs (n=22) included in review (arranged chronologically), mean and SD reported unless otherwise noted

Reference; country	Cohort age (mean)	Female (%)	FEV1 % predicted baseline	Study uptake rate (%)	Study dropout rate (%) I:C	Duration to final assessment (weeks)	Counseling
							Target	Provided by (training if reported)	Mins × number of sessions (weeks duration)	Theoretical framework	S or P of I	Ind or G	Session attendance
Coultas et al;^Citation36 the USA	70	51	NR	6	24:22	72	PA	Health coach (trained by principal investigator + health psychologist)	Mean 10×10 (20) (+10 messages)	SCT + TMSC	P	Ind	7±3 calls per patient
Ranjita et al;^Citation58 India	54	NR	NR	29	12:10	12	Stress-M	Trained yoga instructors	10×72 (12)	NR	P	G and Ind
Altenburg et al;^Citation33 the Netherlands	*62 (54–69)	34	*45 (34–59)	90	29:30	60	PA	Trained exercise counselors	30×5 (12)	SDT + STCT + GST + RPM	S + P**	Ind
Burtin et al;^Citation43 Belgium	67	18	45±16	47	30:0	24	PA	Physiotherapists (3-hour training)	20–30×8 (24)	NR	S	Ind	82%
Hornikx et al;^Citation44 Belgium	67	44	38±17 (I); 48±18 (C)	57	20:0	4	PA	NR	NR ×12 (4)	NR	S	Ind	11±1 calls per patient
Jennings et al;^Citation42 the USA	65	55	44±23 (I); 48±22 (C)	14	0:0	12	SC	NR	Specific SCC NR; NR ×2 (3 days)	NR	P	Ind
Lou et al;^Citation59 China	62	52	*55 (82–45) (I); *55 (8–44) (C)	99	19:30	192	Self-M	General practitioners (2 days training COPD + SCC)	Specific SCC NR; 40–60×48 (96)	NR	P	G and Ind
Mendoza et al;^Citation39 Chile	68	39	66±18 (I); 66±20 (C)	58	4:6	12	PA	Physicians/physiotherapist	30×3 (12)	NR	P	Ind
Van der Weegen et al;^Citation60 the Netherlands	58	51	NR	37	20:14:21	36	PA	Practice nurses	20×4 (24)	NR	P	Ind
Yuan et al;^Citation29 China	54	7	91±11 (I#); 91±11 (C#)	6	19:21	864	SC	NR	Specific SCC or I NR	NR	P	G
Chen et al;^Citation41 China	61	4	NR	NR	NR	24	SC	Doctors experienced in SC treatments	20×1+10×9 (24)	NR	S	Ind
Wei et al;^Citation45 China	64	34	NR	50	28:24	48	Med-A	Pharmacists	10×12 (24)	NR	S	Ind	6±4 calls per patient
Zanotti et al;^Citation32 Italy	64	25	NR	54	0:0	4	NR	NR	NR	NR	P	NR
Hilberink et al;^Citation30 the Netherlands	59	50	NR	NR	5:4	48	SC	General practice team (4-hour group training SC)	NR ×2+ NR ×3 (NR)	NR	S	Ind
Berry et al;^Citation61 the USA	66	46	51±14 (I); 52±12 (C)	25	29:4	48	PA	Center staff	30×3 (48) +15×5 (48)	NR	P	Ind
Hospes et al;^Citation34 the Netherlands	62	40	NR	70	10:11	12	PA	Trained exercise counselor	30×5 (12)	SDT + STCT + GST + RPM	S	Ind
Kotz et al;^Citation31 the Netherlands	54	38	62±6 (I); 63±6 (C); 62±6 (C)	17	12:17:22	48	SC	Respiratory nurses	40×4+5×5 (4)	NR	P	Ind	95% (I) 92% (C1)
Weekes et al;^Citation62 the UK	69	49	44±14 (I); 45±13 (C)	12	36:39	48	D	Dietitian (formal, postgraduate training in counseling)	30 to 45×1+15 to 20×4 (24)	NR	S	Ind
Efraimsson et al;^Citation37 Sweden	66	50	NR	47	NR	12 to 20	SC	Respiratory nurse	Specific SCC NR; I =60×4 (12–20); C =60×2 (12–20)	TMSC	S	Ind
Christenhusz et al;^Citation38 the Netherlands	58	48	NR	NR	NR	48	SC	Counselors/respiratory nurse	Total time – I =595 min; C =180 min	ASE	S	G and Ind
de Blok et al;^Citation35 the Netherlands	64	43	48±21 (I); 44±16 (C)	70	80:73	9	PA	Physical therapists (after being trained)	30×4 (5)	SDT + STCT + GST + RPM	P	Ind
Wagena et al;^Citation40 the Netherlands	51	51	67±13 (I); 65±14 (I); 65±15 (C)	42	12:16:14	26	SC	Trained counselors (masters level)	10–20 min ×3+ NR ×5 (12)	NR	P	Ind

Notes:

* Median and interquartile range.

# Study duration: 18 years for the risk of developing COPD.

** Altenburg et al³³ reported intervention and control as whole cohort and subdivided into three groups: one of these groups completed PR + PA counseling versus PR alone, the other two completed counseling alone versus usual care.

Abbreviations: ASE, attitude–social support and self-efficacy model; D, dietary (energy intake); FEV₁, forced expiratory volume in 1 second; G, group; GST, goal-setting theory; Med-A, medication adherence; NR, not reported; PA, physical activity; PR, pulmonary rehabilitation; RCTs, randomized controlled trial; RPM, relapse prevention model; S, sole; SC, smoking cessation; SCC, smoking cessation counseling; SCT, social cognitive theory; SDT, self-determination theory; Self-M, self-management; STCT, stage of change theory; Stress-M, stress management; TMSC, trans-theoretical model of stages of change; P, part of intervention; C, Control or comparator; I, intervention; Ind, individual; C1, control group 1.

Figure 1 Summary of search strategy outcome.

Note: *Secondary analysis replaced with original study resulted in one paper (Wagena et al⁴⁰) preceding publication time frame (2006–2016).
Abbreviation: RCT, randomized controlled trial.

Table 2 Frequency of BCTs described in intervention and control/comparison groups of included studies

Reference	Counseling the sole intervention?	Total BCTs in the intervention group	Total BCTs in the control group
Physical activity
Coultas et al^Citation36	N	10	0
Altenburg et al^Citation33	Y	5	0
Burtin et al^Citation43	Y	4	0
Hornikx et al^Citation44	Y	8	0
Mendoza et al^Citation39	N	4	4
Van der Weegen et al^Citation60	N	7	0
Zanotti et al^Citation32	N	1	0
Berry et al^Citation61	N	11	0
Hospes et al^Citation34	Y	5	1
de Blok et al^Citation35	N	8	0
Mean no of BCTs (n=10)		6.3	0.5
SD		3.1	1.3
Median (interquartile range)		6.0 (5.0)	0.0 (0.0)
Smoking cessation
Jennings et al^Citation42	N	3	0
Yuan et al^Citation29	N	5	0
Chen et al^Citation41	Y	6	0
Hilberink et al^Citation30	Y	3#	0
Kotz et al^Citation31	N	11	8
Efraimsson et al^Citation37	Y	6	0
Christenhusz et al^Citation38	Y	2	1
Wagena et al^Citation40	N	3	2
Mean no of BCTs (n=8)		4.9	1.4
SD		2.9	2.8
Median (interquartile range)		4.0 (3.0)	0.0 (2.0)
Other health behaviors
Lou et al^Citation59	N	11	0
Ranjita et al^Citation58	N	5	0
Wei et al^Citation45	Y	2	0
Weekes et al^Citation62	Y	8	0
Mean no of BCTs (n=4)		6.5	0.0
SD		3.9	0.0
Median (interquartile range)		6.5 (8.0)	0.0 (0.0)

Note:

# Only included intervention without the pharmacological component.

Abbreviations: BCTs, behavior change techniques; N, no; Y, yes.

Figure 2 Frequency of BCTs described in interventions for studies included within this review.

Abbreviation: BCTs, behavior change techniques.

Figure 3 Individual and pooled effects of counseling interventions on physical activity outcomes: standardised mean difference for post-intervention (A) and change values (B) and smoking cessation (C).

Notes: INT 1= intervention 1; INT 2= intervention 2 (i.e., this study had three groups, 2 interventions and a control).

Figure 4 Relationships between prescribed intervention dosage, number of BCTs included in intervention and between-group outcome (effect size) for change in 6MWD for studies of physical activity counseling.

Note: Assessment at 6 months unless otherwise stated.
Abbreviations: BCTs, behavior change techniques; 6MWD, 6-minute walk distance; ES, effect size.

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