The evidence is based on 14 randomized controlled trials and one cluster randomized trial with high risk of bias. The level of evidence is downgraded due to the possible publication bias, lack in blindinig of both participants and personnel, and imprecision of the results. The applicability of the evidence is good. COPD self-management interventions are unlikely to cause harm.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias «Additional comments for included studies...»2 |
|---|---|---|---|---|---|
| SR=systematic review; MA=meta-analysis; COPD=chronic pulmonary disease; FEV1/FVC ratio=forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio; HRQoL=health related quality of life; SGRQ=St. George's Respiratory Questionnaire (SGRQ) | |||||
| «Schrijver J, Lenferink A, Brusse-Keizer M, ym. Sel...»1 | SR/MA | Patients with COPD; origins: Europe, North Africa, Asia, Ocean. FEV1/FVC ratio ranging from 33.6% to 57.0%. settings: hospital, outpatient clinic, primary care, home-based. Participants' mean age ranged from 57 to 74 years, | Intervention: self-management intervention (Table 2. detailed description «Additional comments for included studies...»2) Comparison: usual care |
Outcome 1: HRQoL, as measured by the SGRQ | high |
| Reference | Comments |
|---|---|
| «Schrijver J, Lenferink A, Brusse-Keizer M, ym. Sel...»1 | Inclusion criteria: randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) assessing
the effectiveness of self-management interventions for people with COPD; included
participants were required to have a diagnosis of COPD according to the GOLD classification
criteria (that is, a postbronchodilator forced expiratory volume in one second (FEV1)/
forced vital capacity (FVC) ratio < 0.70); self-management interventions had to be
defined as structured interventions for participants with COPD aimed at improvement
of self-health behaviours and self-management skills using an iterative process. Exclusion criteria: participants with a primary diagnosis of asthma. Interventions classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre or in a community-based setting were excluded. Description of the intervention: structured interventions aimed at improvement of self-health behaviours and self-management skills using an iterative process in at least two of its intervention components (i.e. smoking cessation, self-recognition of exacerbations, use of an exacerbation action plan, homebased exercise or physical activity, diet, medication intake (e.g. adherence, inhalation technique) or coping with breathlessness). The process included at least two contact moments, in which goals were formulated, and feedback was given to develop participants' self-management skills. A written action plan was part of the self-management intervention in 85% of the original studies; |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (95% CI) I | Absolute number of events, C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| RCT=Randomized controlled trial; CRT=cluster randomized trial; I= intervention; C=comparison; CI=confidence interval | |||||
| «Schrijver J, Lenferink A, Brusse-Keizer M, ym. Sel...»1 | 14 RCTs and one CRT, 2778 (1430/ 1348) | 3-12 months | Mean difference 2.86 points lower in intervention group than in comparison group (4.87 lower to 0.85 lower) | The mean HRQoL ranged from 30.9 to 71.1 points | - |
| Level of evidence: low The quality of evidence is downgraded due to the possible publication bias, lack in blindinig of both participants and personnel, and imprecision of the results. |
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