Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis

被引：56

作者：

Jonkman, Nini H. ^{[1
]}

Westland, Heleen ^{[1
]}

Trappenburg, Jaap C. A. ^{[1
]}

Groenwold, Rolf H. H. ^{[2
]}

Bischoff, Erik W. M. A. ^{[3
]}

Bourbeau, Jean ^{[4
]}

Bucknall, Christine E. ^{[5
]}

Coultas, David ^{[6
,7
]}

Effing, Tanja W. ^{[8
]}

Epton, Michael J. ^{[9
]}

Gallefoss, Frode ^{[10
]}

Garcia-Aymerich, Judith ^{[11
,12
,13
]}

Lloyd, Suzanne M. ^{[14
]}

Monninkhof, Evelyn M. ^{[2
]}

Nguyen, Huong Q. ^{[15
]}

van der Palen, Job ^{[16
,17
]}

Rice, Kathryn L. ^{[18
,19
]}

Sedeno, Maria ^{[4
]}

Taylor, Stephanie J. C. ^{[20
]}

Troosters, Thierry ^{[21
]}

Zwar, Nicholas A. ^{[22
]}

Hoes, Arno W. ^{[2
]}

Schuurmans, Marieke J. ^{[1
]}

机构：

[1] Univ Med Ctr Utrecht, Dept Rehabil Nursing Sci & Sports, HP W01-121,Heidelberglaan 100, NL-3508 GA Utrecht, Netherlands

[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[3] Radboud Univ Nijmegen, Med Ctr, Dept Primary & Community Care, Nijmegen, Netherlands

[4] McGill Univ, Ctr Hlth, Dept Med, Resp Epidemiol & Clin Res Unit, Montreal, PQ, Canada

[5] Glasgow Royal Infirm, Dept Resp Med, Glasgow, Lanark, Scotland

[6] Vet Adm Portland Hlth Care Syst, Portland, OR USA

[7] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[8] Repatriat Gen Hosp, Dept Resp Med, Adelaide, SA, Australia

[9] Christchurch Hosp, Canterbury Dist Hlth Board, Resp Serv, Christchurch, New Zealand

[10] Sorlandet Hosp, Dept Pulm Med, Kristiansand, Norway

[11] Ctr Res Environm Epidemiol CREAL, Barcelona, Spain

[12] Pompeu Fabra Univ, Barcelona, Spain

[13] CIBERER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain

[14] Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland

[15] Kaiser Permanente Southern Calif, Dept Res & Evaluat, Pasadena, CA USA

[16] Univ Twente, Dept Res Methodol Measurement & Data Anal, Enschede, Netherlands

[17] Med Spectrum Twente, Dept Clin Epidemiol, Enschede, Netherlands

[18] Minneapolis Vet Affairs Hlth Care Serv, Div Pulm Allergy Crit Care & Sleep Med, Minneapolis, MN USA

[19] Univ Minnesota, Minneapolis, MN USA

[20] Queen Mary Univ London, Ctr Primary Care & Publ Hlth, London, England

[21] Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium

[22] UNSW Australia, Sch Publ Hlth & Community Med, Sydney, NSW, Australia

来源：

INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 2016年 / 11卷

基金：

美国国家卫生研究院;

关键词：

chronic obstructive pulmonary disease; individual patient data meta-analysis; self-management; subgroup analysis; OBSTRUCTIVE PULMONARY-DISEASE; QUALITY-OF-LIFE; RANDOMIZED-TRIALS; ACTION PLAN; PROGRAM; CARE; EXACERBATION; EDUCATION; SUPPORT;

D O I：

10.2147/COPD.S107884

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

100201 [内科学];

摘要：

Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00-0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66-0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69-0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

引用

页码：2063 / 2074

页数：12

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