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Meta-analysis: chronic disease self-management programs for older adults.
Joshua Chodosh1, Sally C Morton, Walter Mojica
1Southern California Evidence-based Practice Center, RAND Health Division, Santa Monica, USA.
Annals of Internal Medicine
|September 21, 2005
Summary
Self-management programs show benefits for diabetes and hypertension, improving key health markers. However, their effectiveness for osteoarthritis pain and function remains unclear, and essential program components are undetermined.
Area of Science:
- Evidence-based medicine
- Chronic disease management
- Health services research
Background:
- Growing interest in self-management programs for chronic conditions.
- Conflicting data exist on the effectiveness and essential components of these programs.
Purpose of the Study:
- To assess the effectiveness of self-management programs for hypertension, osteoarthritis, and diabetes mellitus.
- To identify the essential components of successful self-management programs.
Main Methods:
- Systematic review and meta-analysis of randomized trials.
- Searched multiple databases (Cochrane Library, MEDLINE, PsycINFO) through September 2004.
- Extracted data on tailored adjustments, group setting, feedback, psychological services, and physician involvement.
Main Results:
- Self-management interventions significantly reduced hemoglobin A1c by 0.81% and blood pressure (systolic by 5 mm Hg, diastolic by 4.3 mm Hg).
- Statistically significant but clinically trivial effects were observed for osteoarthritis pain and function.
- No specific program characteristics were consistently identified as essential for success.
Conclusions:
- Self-management programs likely offer clinically important benefits for diabetes mellitus and hypertension.
- The key elements driving program success remain undetermined, hindering optimization.
- Osteoarthritis self-management programs did not demonstrate clinically beneficial effects on pain or function.
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