Self-management of health care behaviors for COPD: a systematic review and meta-analysis

Kate Jolly,1 Saimma Majothi,1 Alice J Sitch,1 Nicola R Heneghan,2 Richard D Riley,3 David J Moore,1 Elizabeth J Bates,1 Alice M Turner,4 Susan E Bayliss,1 Malcolm J Price,1 Sally J Singh,5 Peymane Adab,1 David A Fitzmaurice,1 Rachel E Jordan11Institute of Applied Health Research, 2School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, 3Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, 4Institute of Inflammation and Ageing, University of Birmingham, Birmingham, 5Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UKPurpose: This systematic review aimed to identify the most effective components of interventions to facilitate self-management of health care behaviors for patients with COPD. PROSPERO registration number CRD42011001588.Methods: We used standard review methods with a systematic search to May 2012 for randomized controlled trials of self-management interventions reporting hospital admissions or health-related quality of life (HRQoL). Mean differences (MD), hazard ratios, and 95% confidence intervals (CIs) were calculated and pooled using random-effects meta-analyses. Effects among different subgroups of interventions were explored including single/multiple components and multicomponent interventions with/without exercise.Results: One hundred and seventy-three randomized controlled trials were identified. Self-management interventions had a minimal effect on hospital admission rates. Multicomponent interventions improved HRQoL (studies with follow-up >6 months St George’s Respiratory Questionnaire (MD 2.40, 95% CI 0.75–4.04, I2 57.9). Exercise was an effective individual component (St George’s Respiratory Questionnaire at 3 months MD 4.87, 95% CI 3.96–5.79, I2  0%).Conclusion: While many self-management interventions increased HRQoL, little effect was seen on hospital admissions. More trials should report admissions and follow-up participants beyond the end of the intervention. Keywords: COPD, self-management, systematic review, meta-analysi