School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review

Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis

“…Study quality varied according to domain, and for some domains, the risk of bias was deemed to be high in studies (see the full review for further details11). However, the overall the potential for this risk of bias to compromise the results of the meta-analyses for the primary outcomes was deemed to be ‘not serious’ when grading the quality of the evidence and the strength of the recommendations.…”

“…Effect sizes from half of the studies included in the meta-analysis indicated that the intervention had a negative impact in slightly or significantly increasing the number of school absences in the intervention group relative to the control. Prespecified subgroup analyses generally did not suggest that study-level characteristics explained between study heterogeneity, although one subgroup analysis (described in the full Cochrane review11) indicated that studies drawing on a defined theoretical framework were more effective (SMD −0.20, 95% CI −0.36 to −0.04; studies=6) than those that did not (SMD 0.08, 95% CI −0.05 to 0.20; studies=4), although there remained moderate levels of heterogeneity for both subgroups (figure 4). Sensitivity analyses based on model assumptions and data transformations did not suggest that the analytical decisions made influenced the effect sizes, and there was negligible evidence of publication bias.…”

“…While the outcomes included in the meta-analyses were only combined after a lengthy consideration of the potential methodological and clinical heterogeneity, there also remains a likelihood that at least part of the heterogeneity observed between studies was due to measurement error. For many of the secondary outcomes that were examined in the companion review,11 for example, lung function, there was even greater heterogeneity in the measurement of outcomes that precluded combining the effect sizes within a meta-analytic framework. In addition to greater efforts for standardisation of outcome domains, this review suggests a need for greater standardisation of appropriate measurement and reporting of outcomes collected within trials.…”

“…Full details of the methods used were published on registration of the protocol for this review through the Cochrane Collaboration 12. The complete review aimed to address two key objectives: (1) identify the key design features and processes associated with successful implementation of school-based asthma self-management interventions and (2) understand whether school-based interventions can effectively change asthma self-management behaviour.…”

“…A search was conducted on the Cochrane Airways Group Specialised Register, which covers a number of databases including CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL as well as respiratory conference abstracts, for trials, using a strategy outlined in the full review11 and developed by the Airways Group Trials Search Co-ordinator (details in acknowledgements). All results were imported into EPPI-Reviewer 4 (systematic review software16) and screened on title and abstract by two reviewers (DK and KH).…”