Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis.
Nini H JonkmanHeleen WestlandJaap C A TrappenburgRolf H H GroenwoldErik W M A BischoffJean BourbeauChristine E BucknallDavid CoultasTanja W EffingMichael EptonFrode GallefossJudith Garcia-AymerichSuzanne M LloydEvelyn M MonninkhofHuong Q NguyenJob van der PalenKathryn L RiceMaria F SedenoStephanie J C TaylorThierry TroostersNicholas A ZwarArno W HoesMarieke J SchuurmansPublished in: The European respiratory journal (2016)
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.
Keyphrases
- physical activity
- systematic review
- chronic obstructive pulmonary disease
- end stage renal disease
- randomized controlled trial
- chronic kidney disease
- lung function
- ejection fraction
- clinical trial
- study protocol
- newly diagnosed
- metabolic syndrome
- electronic health record
- open label
- peritoneal dialysis
- adipose tissue
- prognostic factors
- case report
- single cell
- cystic fibrosis
- meta analyses
- deep learning
- data analysis