Self‐management education for patients with chronic obstructive pulmonary disease

Tanja Effing; Evelyn EM Monninkhof; Paul P.D.L.P.M. van der Valk; Gerhard GA Zielhuis; E. Haydn Walters; Job J van der Palen; Marlies Zwerink

doi:10.1002/14651858.CD002990.pub2

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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Summary of findings table for outcomes relating to quality of life, dyspnoea, exacerbations and healthcare use.

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Figure 3

Forest plot of comparison: 1 Self‐management versus control, outcome: 1.1 HRQOL: SGRQ total.

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Figure 4

Forest plot of comparison: 1 Self‐management versus control, outcome: 1.16 Respiratory‐related hospital admissions.

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Figure 5

Ten high risk patients (51% risk of admission without treatment) treated with Self‐management education prevented one hospital admission over one year

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Figure 6

24 low risk patients (13% risk of admission) treated with self‐management education prevented one admission over one year

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Analysis 1.1

Comparison 1 Self‐management versus control, Outcome 1 HRQOL: SGRQ total.

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Analysis 1.2

Comparison 1 Self‐management versus control, Outcome 2 HRQOL: SGRQ symptoms.

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Analysis 1.3

Comparison 1 Self‐management versus control, Outcome 3 HRQOL: SGRQ activity.

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Analysis 1.4

Comparison 1 Self‐management versus control, Outcome 4 HRQOL: SGRQ impacts.

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Analysis 1.5

Comparison 1 Self‐management versus control, Outcome 5 HRQOL: CRQ dyspnea.

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Analysis 1.6

Comparison 1 Self‐management versus control, Outcome 6 HRQOL: CRQ fatigue.

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Analysis 1.7

Comparison 1 Self‐management versus control, Outcome 7 HRQOL: CRQ emotional function.

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Analysis 1.8

Comparison 1 Self‐management versus control, Outcome 8 HRQOL: CRQ mastery.

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Analysis 1.9

Comparison 1 Self‐management versus control, Outcome 9 General HRQOL: SIP Total score.

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Analysis 1.10

Comparison 1 Self‐management versus control, Outcome 10 General HRQoL: SIP physical.

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Analysis 1.11

Comparison 1 Self‐management versus control, Outcome 11 General HRQoL : SIP psychosocial.

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Analysis 1.12

Comparison 1 Self‐management versus control, Outcome 12 HRQOL: SF‐36 Total + domains.

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Analysis 1.13

Comparison 1 Self‐management versus control, Outcome 13 Borg score dyspnoea.

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Analysis 1.14

Comparison 1 Self‐management versus control, Outcome 14 Patients using at least one course of oral steroids.

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Analysis 1.15

Comparison 1 Self‐management versus control, Outcome 15 Patients using at least one course of antibiotics.

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Analysis 1.16

Comparison 1 Self‐management versus control, Outcome 16 Respiratory‐related hospital admissions.

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Analysis 1.17

Comparison 1 Self‐management versus control, Outcome 17 All cause hospital admissions.

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Analysis 1.18

Comparison 1 Self‐management versus control, Outcome 18 Emergency department visits per person per year.

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Analysis 1.19

Comparison 1 Self‐management versus control, Outcome 19 Doctor and nurse visits: mean number per person per year.

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Analysis 1.20

Comparison 1 Self‐management versus control, Outcome 20 Days lost from work: mean number per person per year.

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Analysis 1.21

Comparison 1 Self‐management versus control, Outcome 21 Lung function: FEV1% pred.

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Analysis 1.22

Comparison 1 Self‐management versus control, Outcome 22 Exercise capacity: 6MW.

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Analysis 1.23

Comparison 1 Self‐management versus control, Outcome 23 Smokers (number of smokers).

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Analysis 2.1

Comparison 2 Subgroup analyses, Outcome 1 Respiratory‐related hospital admissions (subgroup by follow‐up).

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Analysis 2.2

Comparison 2 Subgroup analyses, Outcome 2 Respiratory‐related hospital admissions (subgroup by type of intervention).

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Analysis 2.3

Comparison 2 Subgroup analyses, Outcome 3 doctor and nurse visits: mean number per person per year.

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Table 1. NNTs and event rates for respiratory‐related hospitalisations

Study ID	Control %	Duration	NNT
Bourbeau 2003	51	52	10 (6 to 35)
Boxall 2005	22	12	15 (10 to 52)
Coultas 2005a/b	10	24	30 (20 to 100)
Gallefoss 1999a	13	52	24 (16 to 80)
Littlejohns 1991	22	52	15 (10 to 52)
Monninkhof 2003	13	52	24 (16 to 80)
Rea 2004	38	52	11 (7 to 37)

Table 1. NNTs and event rates for respiratory‐related hospitalisations

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Comparison 1. Self‐management versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 HRQOL: SGRQ total Show forest plot	7	698	Mean Difference (IV, Fixed, 95% CI)	‐2.58 [‐5.14, ‐0.02]

2 HRQOL: SGRQ symptoms Show forest plot	7	698	Mean Difference (IV, Fixed, 95% CI)	‐1.45 [‐4.41, 1.51]

3 HRQOL: SGRQ activity Show forest plot	7	698	Mean Difference (IV, Fixed, 95% CI)	‐2.88 [‐5.90, 0.13]

4 HRQOL: SGRQ impacts Show forest plot	7	698	Mean Difference (IV, Fixed, 95% CI)	‐2.83 [‐5.65, ‐0.02]

5 HRQOL: CRQ dyspnea Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6 HRQOL: CRQ fatigue Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

7 HRQOL: CRQ emotional function Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

8 HRQOL: CRQ mastery Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9 General HRQOL: SIP Total score Show forest plot	3	249	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐4.00, 4.60]

10 General HRQoL: SIP physical Show forest plot	2	201	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

11 General HRQoL : SIP psychosocial Show forest plot	2	201	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

12 HRQOL: SF‐36 Total + domains Show forest plot	3		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.1 SF‐36 ‐ total	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.2 SF‐36 ‐ physical functioning	3	268	Mean Difference (IV, Fixed, 95% CI)	0.59 [‐8.64, 9.83]
12.3 SF‐36 ‐ role limitations ‐ physical	3	268	Mean Difference (IV, Fixed, 95% CI)	3.33 [‐9.22, 15.87]
12.4 SF36 ‐ bodily pain	3	268	Mean Difference (IV, Fixed, 95% CI)	8.91 [‐2.49, 20.32]
12.5 SF‐36 ‐ social limitations	3	268	Mean Difference (IV, Fixed, 95% CI)	‐1.90 [‐13.70, 9.90]
12.6 SF‐36 ‐ mental health	3	268	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐7.70, 7.72]
12.7 SF‐36 ‐ role limitations ‐ emotional	3	268	Mean Difference (IV, Fixed, 95% CI)	‐4.64 [‐17.79, 8.51]
12.8 SF‐36 ‐ vitality, energy, fatigue	3	268	Mean Difference (IV, Fixed, 95% CI)	4.21 [‐4.19, 12.61]
12.9 SF‐36 ‐ general health	3	268	Mean Difference (IV, Fixed, 95% CI)	‐0.70 [‐9.73, 8.33]
13 Borg score dyspnoea Show forest plot	2	144	Mean Difference (IV, Fixed, 95% CI)	‐0.53 [‐0.96, ‐0.10]

14 Patients using at least one course of oral steroids Show forest plot	3	291	Odds Ratio (M‐H, Fixed, 95% CI)	1.44 [0.91, 2.30]

15 Patients using at least one course of antibiotics Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

16 Respiratory‐related hospital admissions Show forest plot	8	966	Odds Ratio (M‐H, Fixed, 95% CI)	0.64 [0.47, 0.89]

17 All cause hospital admissions Show forest plot	3	286	Odds Ratio (M‐H, Fixed, 95% CI)	1.55 [0.87, 2.75]

18 Emergency department visits per person per year Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

18.1 Emergency department visits per person per year (all causes)	2	280	Mean Difference (IV, Random, 95% CI)	0.37 [‐1.97, 2.71]
18.2 Emergency department visits per person per year (lung diseases)	4	328	Mean Difference (IV, Random, 95% CI)	0.07 [‐0.17, 0.31]
19 Doctor and nurse visits: mean number per person per year Show forest plot	8		Mean Difference (IV, Random, 95% CI)	Subtotals only

19.1 doctor and nurse visits: mean number per person per year	8	875	Mean Difference (IV, Random, 95% CI)	0.02 [‐1.10, 1.13]
19.2 doctor and nurse visits: mean number per person per year (all)	1	88	Mean Difference (IV, Random, 95% CI)	4.0 [‐0.51, 8.51]
20 Days lost from work: mean number per person per year Show forest plot	2	121	Mean Difference (IV, Fixed, 95% CI)	‐17.5 [‐50.05, 15.05]

21 Lung function: FEV1% pred Show forest plot	6	552	Std. Mean Difference (IV, Fixed, 95% CI)	0.04 [‐0.12, 0.21]

22 Exercise capacity: 6MW Show forest plot	3	413	Mean Difference (IV, Fixed, 95% CI)	‐6.25 [‐24.05, 11.55]

23 Smokers (number of smokers) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 1. Self‐management versus control

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Comparison 2. Subgroup analyses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Respiratory‐related hospital admissions (subgroup by follow‐up) Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 <12 month follow‐up	3	197	Odds Ratio (M‐H, Fixed, 95% CI)	1.09 [0.45, 2.60]
1.2 >12 month follow‐up	5	769	Odds Ratio (M‐H, Fixed, 95% CI)	0.59 [0.42, 0.84]
2 Respiratory‐related hospital admissions (subgroup by type of intervention) Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Action plan	6	787	Odds Ratio (M‐H, Fixed, 95% CI)	0.60 [0.42, 0.86]
2.2 Other type of intervention	2	179	Odds Ratio (M‐H, Fixed, 95% CI)	0.84 [0.40, 1.74]
3 doctor and nurse visits: mean number per person per year Show forest plot	6		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Action plan	4	292	Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐1.49, 0.80]
3.2 Other type of intervention	2	144	Mean Difference (IV, Fixed, 95% CI)	‐0.27 [‐0.67, 0.12]

Comparison 2. Subgroup analyses

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