TY - JOUR
T1 - Characteristics of effective self-management interventions in patients with COPD
T2 - Individual patient data meta-analysis
AU - Jonkman, Nini H.
AU - Westland, Heleen
AU - Trappenburg, Jaap C A
AU - Groenwold, Rolf H H
AU - Bischoff, Erik W M A
AU - Bourbeau, Jean
AU - Bucknall, Christine E.
AU - Coultas, David
AU - Effing, Tanja W.
AU - Epton, Michael
AU - Gallefoss, Frode
AU - Garcia-Aymerich, Judith
AU - Lloyd, Suzanne M.
AU - Monninkhof, Evelyn M.
AU - Nguyen, Huong Q.
AU - Van Der Palen, Job
AU - Rice, Kathryn L.
AU - Sedeno, Maria
AU - Taylor, Stephanie J C
AU - Troosters, Thierry
AU - Zwar, Nicholas A.
AU - Hoes, Arno W.
AU - Schuurmans, Marieke J.
N1 - Publisher Copyright:
Copyright © ERS 2016.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
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U2 - 10.1183/13993003.01860-2015
DO - 10.1183/13993003.01860-2015
M3 - Article
C2 - 27126694
AN - SCOPUS:84977159771
SN - 0903-1936
VL - 48
SP - 55
EP - 68
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
ER -