Effectiveness of self-management programme in people with chronic kidney disease: A pragmatic randomized controlled trial 慢性肾病患者自我管理方案的有效性:一项实效随机对照试验

Aims: To examine the effectiveness of a self-management intervention compared with usual care in adults with chronic kidney disease (CKD) on self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure. Design: A parallel group randomized controlled trial. Methods: Patients aged ≥\ua018\ua0years with CKD stages 3–5 were recruited between November 2015 and June 2016. Participants were randomly allocated into either the intervention (N\ua0=\ua068) or control group (N\ua0=\ua067). The control group received usual care, while the intervention group received usual care plus a self-management programme from a nurse. The intervention was guided by social cognitive theory (SCT) and included a face-to-face educational session followed by telephone support. Both groups were followed for 16\ua0weeks. Results: There were no significant differences in self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure between the two groups at baseline. At week 16, compared with the control group, large effect sizes for improved self-management, knowledge, and self-efficacy were detected. For health-related quality of life, the physical and mental health components significantly improved. However, no significant differences in either systolic or diastolic blood pressures were found. Conclusion: In earlier stages of CKD, a simple self-management education benefits patients. Impact: Effective self-management in the earlier stages of CKD contributes to slowing its progression, improving health outcomes and lowering the burden on healthcare systems. This study demonstrated that SCT increases CKD self-management by strengthening knowledge and self-efficacy. Nurses can give this education. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616000038493