Using a Taxonomy to Systematically Identify and Describe Self-Management Interventions Components in Randomized Trials for COPD

Abstract

Self-management interventions (SMIs) may improve outcomes in Chronic Obstructive Pulmonary Disease (COPD). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study systematically describes intervention components and characteristics in randomized controlled trials (RCTs) related to COPD self-management using the COMPAR-EU taxonomy as a framework, identifying components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Overall, 235 RCTs published between 2010 and 2018, from a systematic review were coded using the taxonomy, which includes 132 components across four domains: intervention characteristics, expected patient (or caregiver) self-management behaviours, patient relevant outcomes, and target population characteristics. Risk of bias was also assessed. Interventions mainly focused on physical activity (67.4%), and condition-specific behaviours like breathing exercise (63.5%), self-monitoring (50.8%), and medication use (33.9%). Support techniques like education and skills-training, self-monitoring, and goal setting (over 35% of the RCTs) were mostly used for this. Emotional-based techniques, problem-solving, and shared decision-making were less frequently reported (less than 15% of the studies). Numerous SMIs components were insufficiently incorporated into the design of COPD SMIs or insufficiently reported. Characteristics like mode of delivery, intensity, location, and providers involved were often not described. Only 8% of the interventions were tailored to the target population’s characteristics. Outcomes that are considered important by patients were hardly taken into account. There is still a lot to improve in both the design and description of SMIs for COPD. Using a framework such as the COMPAR-EU SMI taxonomy may contribute to better reporting and to better informing of replication efforts. In addition, prospective use of the taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective SMIs in COPD.

Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map

“…Regarding the reporting of interventions, we found much missing data on the exact way interventions were designed, the intensity of interventions, and how outcomes in studies were operationalized and measured. These findings are in agreement with the findings of comparable studies in COPD and obesity that were conducted within COMPAR-EU and also found gaps in the reporting of mode of delivery, intensity, location and providers involved and a huge variety in the way these variables were reported across studies [28,29]. This study showed that 20% of the SMIs were tailored, which means that the content of the intervention or the way it was delivered was adapted to the study population.…”

“…This study showed that 20% of the SMIs were tailored, which means that the content of the intervention or the way it was delivered was adapted to the study population. This percentage is higher than the percentage of tailored studies on SMIs in COPD and obesity, which were below 5% [28,29] and points to the fact that diabetes is generally a precursor in self-management research as compared to other chronic conditions [20]. Tailoring interventions in both design and content is a way to realize more person-centered care [24].…”

Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials

“…In terms of intervention reporting, our investigation revealed a significant absence of information regarding the precise design, intensity, and operationalization of outcomes. These findings are consistent with similar studies conducted within the COMPAR-EU initiative for chronic conditions like T2DM, COPD, and obesity, which also identified deficiencies in reporting mode of delivery, intensity, location, and provider involvement, along with significant heterogeneity in the reporting of these variables across studies [23,24].…”

Self-management interventions for adults living with obesity to improve patient-relevant outcomes: An evidence map

“…To our knowledge, this is the first evidence map providing details on the characteristics of existing SMI for people living with overweight or obesity. We recently performed the description of SMIs components in RCTs for chronic obstructive pulmonary disease within “COMPAR-EU” project following the rapid reviews method proposed by Cochrane [45] . Again, self-management support techniques like education, self-monitoring and goal setting were the most frequently used.…”

“…Again, self-management support techniques like education, self-monitoring and goal setting were the most frequently used. However, outcomes considered important by patients were hardly taken into account [45] . We identified one previous evidence map that focused on describing obesity related determinants, specifically how psychological factors were associated with the development of obesity, but did not provide details of existing SMIs [46] .…”