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

Abstract

BackgroundSelf-management interventions (SMIs) are recommended for individuals with COPD to help monitor symptoms and optimize 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 aimed to summarize the current evidence base surrounding the effectiveness of SMIs for improving HRQOL in people with COPD.MethodsSystematic reviews that focused upon SMIs were eligible for inclusion. Intervention descriptions were coded for behavior change techniques (BCTs) that targeted self-management behaviors to address 1) symptoms, 2) physical activity, and 3) mental health. Meta-analyses and meta-regression were used to explore the association between health behaviors targeted by SMIs, the BCTs used, patient illness severity, and modes of delivery, with the impact on HRQOL and emergency department (ED) visits.ResultsData related to SMI content were extracted from 26 randomized controlled trials identified from 11 systematic reviews. Patients receiving SMIs reported improved HRQOL (standardized mean difference =−0.16; 95% confidence interval [CI] =−0.25, −0.07; P=0.001) and made fewer ED visits (standardized mean difference =−0.13; 95% CI =−0.23, −0.03; P=0.02) compared to patients who received usual care. Patients receiving SMIs targeting mental health alongside symptom management had greater improvement of HRQOL (Q=4.37; P=0.04) and fewer ED visits (Q=5.95; P=0.02) than patients receiving SMIs focused on symptom management alone. Within-group analyses showed that HRQOL was significantly improved in 1) studies with COPD patients with severe symptoms, 2) single-practitioner based SMIs but not SMIs delivered by a multidisciplinary team, 3) SMIs with multiple sessions but not single session SMIs, and 4) both individual- and group-based SMIs.ConclusionSMIs 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.

Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals

“…Recent reviews focusing on the effectiveness of COPD self-management interventions suggest interventions can improve HRQoL and disease symptoms, reducing hospital admissions. 17 , 19 , 20 However, patient engagement can be influenced by structural, disease-related, social, and psychological factors (e.g., short consultations, comorbidities, health literacy, social support, depression, anxiety). 22 – 26 The social, emotional, and medical needs of those with COPD are varied and complex, making it a challenging condition to self-manage and support.…”

Self-management strategy in training programs for patients with chronic obstructive pulmonary disease

“…org/10.1177/1479972316687208. Newham, J.J. et al (2017), "Features of self-management interventions for people with COPd associated with improved health-27. related quality of life and reduced emergency department visits: a systematic review and meta-analysis", International journal of chronic obstructive pulmonary disease, New Zealand, (12), pp.…”

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“…A multisite study of outcomes of standardized asthma education demonstrated substantial improvements in the burden of asthma for those seen by the CCAP CREs (unscheduled physician visits, emergency visits, hospital utilization, missed work, and school or leisure days as well as significant improvements in quality of life) [37]. Numerous reviews of client education aimed at self-management of asthma and COPD also support the services offered by CCAP to reduce acute health care utilization, COPD, and asthma exacerbation and to support improved lung function [34,35,[38][39][40][41][42][43][44][45].…”