Abstract
Background: Self-management interventions are considered effective in COPD patients, but trials have shown inconsistent results and it is unknown which patients benefit most.
Aims: To summarise the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most.
Methods: Randomised trials on self-management interventions between 1985 and 2013 were identified through a systematic literature search. The original data of selected studies were analysed using generalised mixed effects models.
Results: Fourteen trials representing 3282 patients were included. Self-management improved health-related quality of life (standardised mean difference 0.08, 95%CI 0.00-0.16), COPD-related hospitalisation (hazard ratio 0.79, 95%CI 0.66-0.94) and all-cause hospitalisation (hazard ratio 0.80, 95%CI 0.69-0.90), but had no effect on mortality. Pre-specified subgroup analysis showed significant interactions for certain outcomes: interventions were more effective in males (6-month COPD-related hospitalisation: P=0.006), patients with severe lung function (6-month all-cause hospitalisation: P=0.016), moderate self-efficacy (12-month COPD-related hospitalisation: P=0.036), and high body mass index (6-month-COPD-related hospitalisation: P=0.028; and 6-month mortality: P=0.026).
Conclusion: Self-management improved health-related quality of life, COPD-related and all-cause hospitalisation in COPD patients. Our findings support implementation of self-management strategies in practice and suggest subgroups with greater benefit. However, the inconsistent subgroup effects across outcomes do not endorse targeting to subgroups at this stage of our understanding.
- Copyright ©ERS 2015