학술논문
Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis.
Document Type
Academic Journal
Author
Jonkman NH; Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands n.jonkman@umcutrecht.nl.; Westland H; Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.; Trappenburg JC; Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.; Groenwold RH; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.; Bischoff EW; Dept of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.; Bourbeau J; Respiratory Epidemiology and Clinical Research Unit, Dept of Medicine, McGill University Health Center, McGill University, Montreal, Canada.; Bucknall CE; Dept of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.; Coultas D; Veterans Administration Portland Health Care System and Oregon Health & Science University, Portland, OR, USA.; Effing TW; Dept of Respiratory Medicine, Repatriation General Hospital, Adelaide, Australia.; Epton M; Canterbury District Health Board, Respiratory Services, Christchurch Hospital, Christchurch, New Zealand.; Gallefoss F; Dept of Pulmonary Medicine, Sorlandet Hospital, Kristiansand, Norway.; Garcia-Aymerich J; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.; Lloyd SM; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.; Monninkhof EM; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.; Nguyen HQ; Dept of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.; van der Palen J; Dept of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands Department of Clinical Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.; Rice KL; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care Service and University of Minnesota, Minneapolis, USA.; Sedeno M; Respiratory Epidemiology and Clinical Research Unit, Dept of Medicine, McGill University Health Center, McGill University, Montreal, Canada.; Taylor SJ; Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.; Troosters T; Dept of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium.; Zwar NA; School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.; Hoes AW; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.; Schuurmans MJ; Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
Source
Publisher: European Respiratory Society Country of Publication: England NLM ID: 8803460 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3003 (Electronic) Linking ISSN: 09031936 NLM ISO Abbreviation: Eur Respir J Subsets: MEDLINE
Subject
Language
English
Abstract
It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective.Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. Individual patient data were requested for meta-analysis by generalised mixed effects models.14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97-0.99; risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92-0.99; RR after 12 months follow-up 0.98, 95% CI 0.96-1.00).Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes.
(The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.)
(The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2016.)