Self‐management education programmes by lay leaders for people with chronic conditions

Gill Foster; Stephanie JC Taylor; Sandra Eldridge; Jean Ramsay; Chris J Griffiths

doi:10.1002/14651858.CD005108.pub2

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Analysis 1.1

Comparison 1 Pain up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 2.1

Comparison 2 Pain more than 6 months follow up, Outcome 1 Change from baseline.

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Analysis 3.1

Comparison 3 Disability/impaired physical function up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 4.1

Comparison 4 Disability more than 6 months follow up, Outcome 1 Change from baseline.

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Analysis 5.1

Comparison 5 Fatigue up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 6.1

Comparison 6 Shortness of breath up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 7.1

Comparison 7 Depression up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 8.1

Comparison 8 Anxiety up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 9.1

Comparison 9 Psychological well being up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 10.1

Comparison 10 Health related quality of life (EQ5D) up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 11.1

Comparison 11 General/self‐rated health (1 item) up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 12.1

Comparison 12 Health distress up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 13.1

Comparison 13 Frequency of aerobic exercise up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 14.1

Comparison 14 Cognitive symptom management up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 15.1

Comparison 15 Physician/GP visits up to 6 months follow up (for Barlow 2000, GP visits for arthritis), Outcome 1 Change from baseline.

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Analysis 16.1

Comparison 16 Number of days/or nights spent in hospital up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 17.1

Comparison 17 Self‐efficacy to manage pain (ASMP) or symptoms/condition (all other) up to 6 months follow up, Outcome 1 Change from baseline.

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Analysis 18.1

Comparison 18 Communication with health professionals up to 6 months follow up, Outcome 1 Change from baseline.

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Table 1. Study quality components table

Study ID	Randomisation	Allocation Conceal	Blinding O A	Blindin D A	Baseline	Attrition bias (a)	ITT analysis	Validation (b)
Barlow 2000	Pre‐generated lists of random allocations	Done	Unclear	Unclear	Yes	32% I 27% C	Yes	Yes
Buszewicz 2006	Computerised system with minimisation	Done	Yes	Unclear	Yes	27.5% I 20% C	Yes	Yes
Cohen 1986	Unclear	Unclear	Unclear	Unclear	Yes	12.5% I 5. 5% C 17% HP (c)	No	Unclear
de Weerdt 1991	Unclear	Unclear	Unclear	Unclear	Yes	Unclear	No	yes
Fu 2003	Random number table	Unclear	Yes	Unclear	Yes	11% I 16% C	Yes, data not presented	Unclear
Gifford 1998	Unclear	Unclear	Unclear	Unclear	Yes	26.5% I 11% C	No	Unclear
Griffiths 2005	Computer minimization programme	Done	Yes	Unclear	Yes	7% I 8% C	No	Yes
Haas 2005	Equal allocation algorithm stratified by race	Unclear	Unclear	Unclear	Yes (d)	38% I 33% C	No	Yes
Kennedy 2007	A computer generated minimisation procedure	Done	Unclear	Unclear	Yes	21% I 14% C (e)	No	Yes
Lorig 1986	Unclear	Unclear	Unclear	Unclear	Yes (f)	21% I 9% C 15% HP	No	Yes, partly
Lorig 1999a	Unclear	Unclear	Unclear	Unclear	Yes	14% I 15.4% C	Yes, data not presented	Yes, partly
Lorig 1999b	Unclear	Unclear	Yes	Unclear	Yes	16% I 18% C	Yes, data not presented	Yes, partly
Lorig 2003	Unclear	Unclear	Yes	Unclear	Yes	19% I 20% C	Yes, data not presented	Yes
Riegel 2004	Pre‐assigned random number sequence	Unclear	Unclear	Unclear	Yes	29% I 33% C	Yes, resource use only	Yes
Summers Holtrop 2002	Unclear	Unclear	Unclear	Unclear	Yes	28% I 35% C	Yes	Yes
Swerissen 2006	Unclear	Unclear	Unclear	Unclear	Yes	31% I 41% C	No	Unclear
Von Korff 1998	Unclear	Unclear	Yes	Unclear	Yes	8% I 13% C * @6m	No	Yes
		a) % attrition in intervention (I), control (c) groups and (HP) health care professional led groups,	b) where some tools/ instruments are validated and others appear not to have been validated and no primary outcomes are given we have scored this as unclear,	c) Health professional group possessed significantly more knowledge than lay led or control group	d) authors' report no important differences between groups however, the control group were 75% more likely to have seen a health care provider in the previous 2 weeks,	e) authors report a differential attrition rate	f) lay led group were significantly older.

Table 1. Study quality components table

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Table 2. Chronic conditions of participants

Study ID	Chronic condition	Method of diagnosis
Barlow 2000	Arthritis	Confirmed by GP
Buszewicz 2006	Osteoarthritis of the hips or knees (or both)	From general practice database
Cohen 1986	Arthritis	Self diagnosed and possibly health professional identified
de Weerdt 1991	Adult diabetics on insulin	Identified by hospital physician
Fu 2003	Hypertension, heart disease, chronic lung disease, arthritis, stroke or diabetes	Confirmed by medical record.
Gifford 1998	HIV+	Identified by health care providers
Griffiths 2005	Diabetes, arthritis, respiratory or cardiovascular disease	From general practice database
Haas 2005	Chronic low back pain	Insufficient details
Summers Holtrop 2002	Type II diabetes	Computerized billing lists
Kennedy 2007	Musculoskeletal, endocrine, circulatory, myalgic encephalitis /chronic fatigue, respiratory, mental health and neurological conditions.	Self defined
Lorig 1986	Arthritis	Confirmed by personal physician
Lorig 1999a	Arthritis	Insufficient details
Lorig 1999b	Chronic lung disease, heart disease or chronic arthritis	Confirmed by physician
Lorig 2003	Heart disease, Lung disease or type II diabetes	Mostly confirmed by a physician, otherwise they were self reported
Riegel 2004	Heart failure	Hospitalised patients
Swerissen 2006	Arthritis, hypertension, diabetes, heart disease, asthma or chronic pain	Confirmed diagnosis, however insufficient details about confirmation.
Von Korff 1998	Chronic low back pain (back pain or strain, a disc disorder, or sciatica).	Identified from diagnoses recorded on automated visit encounter forms

Table 2. Chronic conditions of participants

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Table 3. Included studies ‐ outcome data not used in meta‐analyses

Study ID	Outcome measure	Reason for omission
Barlow 2000	Negative and positive affect, diet and fluids.	No or only one other study used these or similar measures.
Buszewicz 2006	Stiffness (WOMAC).	No other studies used this or a similar measure.
Cohen 1986	Arthritis self management knowledge and behaviour, pain, disability, perceived instrumental support, perceived affective support.	Authors combined the results for lay‐led and health professional led groups.
de Weerdt 1991	Number of hypoglycaemic reactions, severity of attacks, costs of therapy, number of days unable to work, attitude and social norm, anxiety	No or only one other study used these or similar measures. For anxiety no results were presented.
Fu 2003	Illness intrusiveness, social/role activity limitations, energy, stretching exercises, emergency room visits.	No or only one other study used these or similar measures.
Gifford 1998	HIV knowledge, stress/relaxation exercises, stress, anger.	No or only one other study used these or similar measures.
Haas 2005	Number of days with pain, energy‐fatigue.	No or only one other study used these or similar measures.
Kennedy 2007	Relaxation, energy, social role limitations, information seeking, diet, specialist OPD visits, complementary products.	No or only one other study used these or similar measures.
Lorig 1986	Arthritis knowledge, relaxation exercises.	No or only one other study used these or similar measures.
Lorig 1999a	Medication use, NSAIDs, range of motion exercises.	No or only one other study used these or similar measures.
Lorig 1999b	Stretching and strengthening exercise, social/role activities, number of hospital stays.	No or only one other study used these or similar measures.
Lorig 2003	Role function, mental stress management, current tobacco use.	No or only one other study used these or similar measures.
Riegel 2004	Self care maintenance, self care of heart failure, confidence in ability to communicate with physician, social support.	No or only one other study used these or similar measures.
Summers Holtrop 2002	Stages for behaviour change, behaviour risk factor (dietary fat and fruit intake), thoughts and feelings about diabetes.	No other studies used these, or a similar measures.
Swerissen 2006	Health status, health behaviour, self efficacy, health care use, energy, role function, illness intrusiveness.	Data not available as mean change from baseline.
Von Korff 1998	Attitudes towards back pain, self care orientation, mental health inventory, back pain worries, pain intensity and interference.	Data not available as mean change from baseline.

Table 3. Included studies ‐ outcome data not used in meta‐analyses

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Comparison 1. Pain up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	11	4683	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.17, ‐0.04]

1.1 ASMP	4	1450	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.29, 0.09]
1.2 CDSMP	6	3175	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.17, ‐0.03]
1.3 Other	1	58	Std. Mean Difference (IV, Random, 95% CI)	‐0.24 [‐0.76, 0.28]

Comparison 1. Pain up to 6 months follow up

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Comparison 2. Pain more than 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	1	530	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.29, 0.05]

Comparison 2. Pain more than 6 months follow up

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Comparison 3. Disability/impaired physical function up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	8	3491	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.25, ‐0.05]

1.1 ASMP	4	1476	Std. Mean Difference (IV, Random, 95% CI)	‐0.05 [‐0.20, 0.09]
1.2 CDSMP	3	1787	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.30, ‐0.11]
1.3 Other	1	228	Std. Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.54, ‐0.01]

Comparison 3. Disability/impaired physical function up to 6 months follow up

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Comparison 4. Disability more than 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	2	777	Std. Mean Difference (IV, Random, 95% CI)	0.06 [‐0.22, 0.33]

1.1 ASMP	1	559	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.23, 0.10]
1.2 CDSMP	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 Other	1	218	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.05, 0.48]

Comparison 4. Disability more than 6 months follow up

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Comparison 5. Fatigue up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	7	3251	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.23, ‐0.09]

1.1 ASMP	1	544	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.37, ‐0.03]
1.2 CDSMP	5	2649	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.22, ‐0.07]
1.3 Other	1	58	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐0.95, 0.10]

Comparison 5. Fatigue up to 6 months follow up

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Comparison 6. Shortness of breath up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	3	2126	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.25, 0.06]

1.1 CDSMP	3	2126	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.25, 0.06]

Comparison 6. Shortness of breath up to 6 months follow up

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Comparison 7. Depression up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	6	2613	Std. Mean Difference (IV, Random, 95% CI)	‐0.16 [‐0.24, ‐0.07]

1.1 ASMP	3	1426	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.34, ‐0.09]
1.2 CDSMP	2	1129	Std. Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.22, 0.02]
1.3 Other	1	58	Std. Mean Difference (IV, Random, 95% CI)	0.10 [‐0.42, 0.62]

Comparison 7. Depression up to 6 months follow up

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Comparison 8. Anxiety up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	3	1573	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.25, ‐0.04]

1.1 ASMP	2	1137	Std. Mean Difference (IV, Random, 95% CI)	‐0.19 [‐0.31, ‐0.07]
1.2 CDSMP	1	436	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.22, 0.16]

Comparison 8. Anxiety up to 6 months follow up

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Comparison 9. Psychological well being up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	5	2168	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.33, 0.09]

1.1 ASMP	1	432	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.16, 0.21]
1.2 CDSMP	3	1551	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.55, ‐0.01]
1.3 Other	1	185	Std. Mean Difference (IV, Random, 95% CI)	0.21 [‐0.08, 0.50]

Comparison 9. Psychological well being up to 6 months follow up

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Comparison 10. Health related quality of life (EQ5D) up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	3	1269	Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.09, 0.02]

1.1 ASMP	1	164	Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.11, 0.05]
1.2 CDSMP	2	1105	Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.12, 0.05]

Comparison 10. Health related quality of life (EQ5D) up to 6 months follow up

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Comparison 11. General/self‐rated health (1 item) up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	6	3061	Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.31, ‐0.10]

1.1 CDSMP	6	3061	Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.31, ‐0.10]

Comparison 11. General/self‐rated health (1 item) up to 6 months follow up

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Comparison 12. Health distress up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	4	2593	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.34, ‐0.15]

1.1 CDSMP	4	2593	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.34, ‐0.15]

Comparison 12. Health distress up to 6 months follow up

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Comparison 13. Frequency of aerobic exercise up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	7	3040	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.27, ‐0.12]

1.1 ASMP	2	342	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.09, 0.32]
1.2 CDSMP	4	2640	Std. Mean Difference (IV, Random, 95% CI)	‐0.19 [‐0.27, ‐0.11]
1.3 Other	1	58	Std. Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.94, 0.11]

Comparison 13. Frequency of aerobic exercise up to 6 months follow up

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Comparison 14. Cognitive symptom management up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	4	2628	Mean Difference (IV, Random, 95% CI)	‐0.55 [‐0.85, ‐0.26]

1.1 ASMP	1	544	Mean Difference (IV, Random, 95% CI)	‐2.18 [‐2.95, ‐1.41]
1.2 CDSMP	3	2084	Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.40, ‐0.25]

Comparison 14. Cognitive symptom management up to 6 months follow up

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Comparison 15. Physician/GP visits up to 6 months follow up (for Barlow 2000, GP visits for arthritis)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	9	3812	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.09, 0.04]

1.1 ASMP	3	506	Std. Mean Difference (IV, Random, 95% CI)	0.04 [‐0.14, 0.22]
1.2 CDSMP	5	3121	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.11, 0.03]
1.3 Other	1	185	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.21, 0.37]

Comparison 15. Physician/GP visits up to 6 months follow up (for Barlow 2000, GP visits for arthritis)

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Comparison 16. Number of days/or nights spent in hospital up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	6	3310	Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.71, 0.07]

1.1 CDSMP	5	3125	Mean Difference (IV, Random, 95% CI)	‐0.24 [‐0.61, 0.13]
1.2 Other	1	185	Mean Difference (IV, Random, 95% CI)	‐1.3 [‐2.83, 0.23]

Comparison 16. Number of days/or nights spent in hospital up to 6 months follow up

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Comparison 17. Self‐efficacy to manage pain (ASMP) or symptoms/condition (all other) up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	10	3682	Std. Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.41, ‐0.19]

1.1 ASMP	3	1421	Std. Mean Difference (IV, Random, 95% CI)	‐0.35 [‐0.46, ‐0.24]
1.2 CDSMP	5	2146	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.43, ‐0.09]
1.3 Other	2	115	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.87, 0.44]

Comparison 17. Self‐efficacy to manage pain (ASMP) or symptoms/condition (all other) up to 6 months follow up

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Comparison 18. Communication with health professionals up to 6 months follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change from baseline Show forest plot	7	3643	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.25, ‐0.05]

1.1 ASMP	1	544	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.45, ‐0.10]
1.2 CDSMP	5	3038	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.24, ‐0.01]
1.3 Other	1	61	Std. Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.52, 0.48]

Comparison 18. Communication with health professionals up to 6 months follow up

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