Effectiveness of community-based self-management interventions among primary care COPD patients: a systematic review

Abstract

Background: COPD self-management (SM) reduces hospital admissions and improves health related quality of life (HRQoL). However, most SM trials have identified participants from secondary care. This systematic review aimed to determine the effectiveness of SM interventions in primary care patients with COPD. Methods: A comprehensive search strategy from the inception of each electronic database until May 2012 for randomised controlled trials sought: population: people with a diagnosis of COPD recruited from primary care; intervention: support for COPD SM; comparator groups: any; outcomes: primary-HRQoL; secondary included anxiety, depression and health care utilisation. An updated search focussed on primary care was undertaken to July 2016. Study selection was undertaken independently in duplicate; data extraction and risk of bias assessment by one reviewer with a sample checked. Meta-analyses used a random effects model. PROSPERO registration CRD4206043958. Results: From 12,146 abstracts, we identified twelve eligible RCTs; 7 were included in the meta-analyses. Trials ranged from 52 to 8217 participants, last follow-up from 3 months to 4 years. The interventions were heterogeneous; duration ranged from 4 weeks to 2 years. There was no difference in HRQoL at last follow-up (SGRQ total score -0.19, (95%CI -1.28 to 0.89; I2 0%), nor any difference in the CRQ. HADS anxiety was significantly lower in the SM group: -0.85 (95%CI -1.22 to -0.48; I2 16.9%). Discussion Self-management interventions for COPD in primary care show promise in reducing patient anxiety, but no effect on HRQoL. The heterogeneity of outcome measures precluded synthesis of the full evidence.