Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis

被引：63

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 ^{[9
]}

Gallefoss, Frode ^{[10
]}

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

Lloyd, Suzanne M. ^{[14
]}

Monninkhof, Evelyn M. ^{[15
]}

Nguyen, Huong Q. ^{[16
]}

van der Palen, Job ^{[17
,18
]}

Rice, Kathryn L. ^{[19
,20
]}

Sedeno, Maria ^{[4
]}

Taylor, Stephanie J. C. ^{[21
]}

Troosters, Thierry ^{[22
]}

Zwar, Nicholas A. ^{[23
]}

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 G4 0SF, 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] Univ Pompeu Fabra, Barcelona, Spain

[13] CIBERESP, Barcelona, Spain

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

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

[16] Kaiser Permanente Southern Calif, Dept Res & Evaluat, Pasadena, CA 91101 USA

[17] Univ Twente, Dept Res Methodol Measurement & Data Anal, POB 217, NL-7500 AE Enschede, Netherlands

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

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

[20] Univ Minnesota, Minneapolis, MN USA

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

[22] Catholic Univ Louvain, Dept Rehabil Sci, Leuven, Belgium

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

来源：

EUROPEAN RESPIRATORY JOURNAL | 2016年 / 48卷 / 01期

关键词：

OBSTRUCTIVE PULMONARY-DISEASE; LONG-TERM CONDITIONS; QUALITY-OF-LIFE; PRIMARY-CARE; PHYSICAL-ACTIVITY; SUPPORT; EDUCATION; PROGRAMS; PEOPLE; TRIAL;

D O I：

10.1183/13993003.01860-2015

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：

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.

引用

页码：55 / 68

页数：14

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