Self-management interventions for people with chronic obstructive pulmonary disease

Area of Science:

• Pulmonary Medicine
• Health Behavior
• Evidence-Based Practice

Background:

• Self-management interventions empower individuals with chronic obstructive pulmonary disease (COPD) to manage their medical regimens, adopt healthier behaviors, and receive emotional support.
• Recent studies have been published since the last review update in 2014, necessitating an updated evaluation of these interventions.

Purpose of the Study:

• To assess the effectiveness of COPD self-management interventions on health-related quality of life (HRQoL) and respiratory hospital admissions.
• To evaluate the safety of these interventions concerning respiratory and all-cause mortality.
• To explore other health outcomes, healthcare utilization, and effective intervention characteristics.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995.
• Included studies involved self-management interventions with at least two components and iterative participant-healthcare provider interaction.
• Primary outcomes included HRQoL, respiratory hospital admissions, and mortality; data were pooled using random-effects modeling.

Main Results:

• Self-management interventions likely improve HRQoL (St. George's Respiratory Questionnaire score: MD -2.86), though not reaching minimal clinically important difference.
• Participants had a slightly lower risk of respiratory-related hospital admissions (OR 0.75), with NNTs of 15 and 26 for high and low baseline risk, respectively.
• No significant differences were found in respiratory-related or all-cause mortality; evidence quality ranged from moderate to very low, with high risk of bias.

Conclusions:

• COPD self-management interventions are associated with improved HRQoL and reduced hospital admissions, with no increased mortality risk.
• Further research is needed to identify effective intervention characteristics, requiring more homogeneity in outcome measures and detailed reporting of intervention components and behavioral change techniques (BCTs).
• Future studies should focus on iterative interactions, BCTs, long-term outcomes, and transparent reporting to enhance evidence quality.