Self-management Group Research Articles

Evaluation of supported self-management in gout (GoutSMART): a randomised controlled feasibility trial

Improved outcomes for patients with gout are associated with the control of urate levels; yet, less than 40% of patients in the UK are currently offered urate lowering therapy, and it is typically offered without titration to target. Supported self-management has been shown to benefit patients with chronic health conditions; therefore, we aimed to determine whether a supported gout self-management approach, incorporating treatment-to-target urate, helped participants reach target urate levels. In this randomised controlled feasibility study, conducted in one hospital in Edinburgh, UK, we included patients (aged ≥18 years) with gout and a physician recommendation for initiation or escalation of urate lowering therapy. We randomised participants in a 2:1 ratio to a supported self-management group or a usual care group using the GoutSMART smartphone app. Participants in the self-management group were given a urate self-testing meter and received direct advice from clinicians on escalation of urate lowering therapy through the app. Participants were identified following referral to rheumatology, or using the Scottish Health Research Register, and they were screened and offered a detailed management plan before randomisation. Participants in the usual care group had a limited version of the app, which only allowed it to function as a health diary, and their gout management plan was implemented by their general practitioner. The primary outcome was the percentage of participants achieving a urate target of 0·30 mmol/L or less at 24 weeks, and analysis was by intent to treat. The trial was registered with ClinicalTrials.gov, NCT03274063, and there is an extension study ongoing. There was no masking of participants or assessors. Between April 5, 2019, and March 19, 2020, 60 (65%) of 92 patients screened were enrolled to the study. The mean age was 52.8 years (SD 14.6); 56 (93%) of the participants were male, and 4 (7%) were female. 58 (97%) of participants were White. 40 participants were assigned to the self-supported management group and 20 participants were assigned to the usual care group. A urate target of 0·30 mmol/L or less at 24 weeks was reached by 29 (73%) participants in the supported self-management group compared with 3 (15%) participants in the usual care group (risk difference 0·58 [95% CI 0·37-0·78]; p<0·0001). 90% of participants completed the study with no difference in the drop-out rate or adverse events between the two groups. Supported self-management of gout results in substantially improved attainment of urate targets compared with usual care, and it is well tolerated. Larger trials will be needed to fully evaluate the clinical and cost-effectiveness of this approach. Edinburgh & Lothians Health Foundation.

Quality of life and its influencing factors among diabetic patients two years after a self-management intervention in six provinces and cities in China: a follow-up study

Objective To analyze the quality of life (QoL) and its influencing factors among diabetes mellitus patients two years after undergoing a community-based diabetes self-management and to provide references for improving medical service to diabetes. Methods From August to October of 2013, 1 653 diabetic patients were recruited in 84 communities in three cities (Beijing, Shanghai and Chongqing) and three provinces (Jiangsu, Guangdong and Zhejiang) to carry out a 2-month diabetes self-management group intervention. A follow-up survey was conducted during September – December 2015 to analyze changes in QoL and its influencing factors before and after the self-management intervention. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used in QoL evaluation. Results Among the 1 653 diabetic patients recruited in 2013, 1 603 (96.98%) completed a baseline survey, of which, 1 299 patients were followed up and 304 (18.96%) were lost to follow-up in 2015. Compared to those before the intervention, the patients′ median (quartile range, QR) of SF-36 physical health score increased significantly two years after the self-management intervention (76.50 [23.75] vs. 75.00 [25.00], Z = – 2.53; P = 0.011), but the patients′ median (QR) of SF-36 mental health score was not significantly different (78.44 [25.03] vs. 78.44 [23.31], P > 0.05). The results of unconditional multivariate logistic regression analysis demonstrated that two years after receiving the diabetes self-management intervention, the patients suffering from diabetes 5 years or more and smoking were less likely to have an increased physical health score, while those with an improved self-efficacy were more likely to have an increased physical health score; the patients with following characteristics were less likely to have an increased mental health score: female, with medication reimbursement by medical insurance for urban workers, having complication of other chronic disease, smoking, and being capable of self-injection of insulin or not needing insulin injection. Conclusion The quality of life was improved to a certain extent among a group of community diabetic patients in China two years after a self-management intervention and the improvement was influenced by the patients′ gender, major payer of the medication cost, disease course, comorbidity of other chronic diseases, self-efficacy, smoking, and self-injection of insulin.

Self-Management for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background Knee osteoarthritis (KOA) is a high incidence chronic joint disease that seriously affects patients' quality of life, and current treatment methods have limited efficacy. Self-management may be an effective strategy for KOA, and clinicians have been showing increased interest recently. However, the effectiveness of self-management for KOA remains controversial. Purpose This study aims to systematically evaluate the effectiveness of self-management for KOA. Methods We screened articles published in MEDLINE, Cochrane Library, EMBASE, and Web of Science until September 17, 2021. The main outcomes included pain, knee function, stiffness, WOMAC (total), physical function, arthritis self-efficacy (ASE-pain), arthritis self-efficacy (ASE-other symptoms), mental health, and quality of life. Results Thirteen randomized controlled trials (RCTs) were finally included (n = 1610). Meta-analysis showed differences in pain, knee function, stiffness, ASE-pain, ASE-other symptoms, mental health, and quality of life between the self-management and control groups. Of the nine outcomes evaluated, four were highly heterogeneous, and the quality of evidence ranged from very low to moderate. Conclusion The meta-analysis results showed that self-management might help improve the pain, knee function, stiffness, ASE, mental health, and quality of life in patients with KOA. However, it has no significant effect on WOMAC (total) and physical function. Considering that this study has some limitations, we cannot draw clear conclusions based on the results of this study. Nevertheless, we offer much needed insight and encourage more rigorously designed and implemented RCTs in the future to substantiate our conclusions.

Perceptions of a self-management intervention for adolescents with sickle cell disease.

Objective: Individuals with sickle cell disease (SCD) are at increased risk for complications from their disease during their adolescent and young adult (AYA) years. The risk of morbidity in AYAs with SCD can be decreased with improved self-management. Existing self-management interventions typically focus on one aspect of self-management (e.g., adherence) and do not address factors that activate patients (knowledge, motivation, self-efficacy, and social support) to self-manage. Sickle Cell Thrive (SCThrive) is a mixed in-person/online, technology-enhanced (use of a mobile app), group self-management intervention that targets patient activation. To determine the most clinically significant intervention components, a qualitative study was conducted. Method: Participants were 19 AYAs (Mage = 17.05) with SCD who participated in individual semistructured phone interviews after completing SCThrive. Interview content was coded using a grounded-theory approach to generate themes related to SCThrive’s feasibility, acceptability, and motivation for and impact on self-management. Results: SCThrive was reported to be highly feasible due to the mixed in-person/online format and acceptable because they learned skills to manage SCD in a group of AYAs with SCD. Action planning and pain/mood tracking appeared to be key factors in motivating AYAs for self-management. Participants reported continuing to use self-management skills post-SCThrive (self-efficacy) including applying them to other domains of their lives (e.g., educational/vocational). Conclusions: Study results provide data that can be leveraged to enhance the feasibility, acceptability, and impact of SCThrive and other self-management interventions. Findings can also inform clinical and mobile health interventions to increase self-management in this population.

A pragmatic randomized controlled trial of a group self-management support program versus treatment-as-usual for anxiety disorders: study protocol

BackgroundThe integration of a personal recovery-oriented practice in mental health services is an emerging principle in policy planning. Self-management support (SMS) is an intervention promoting recovery that aims at educating patients on the nature of their mental disorder, improving their strategies to manage their day-to-day symptoms, fostering self-efficacy and empowerment, preventing relapse, and promoting well-being. While SMS is well established for chronic physical conditions, there is a lack of evidence to support the implementation of structured SMS programs for common mental disorders, and particularly for anxiety disorders. This study aims to examine the effectiveness of a group-based self-management support program for anxiety disorders as an add-on to treatment-as-usual in community-based care settings.Methods/designWe will conduct a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months.Treatment and control groupsa) group self-management support (10 weekly 2.5-h group web-based sessions with 10–15 patients with two trained facilitators); b) treatment-as-usual. Participants will include adults meeting DSM-5 criteria for Panic Disorder, Agoraphobia, Social Anxiety Disorder, and/or Generalized Anxiety Disorder. The primary outcome measure will be the Beck Anxiety Inventory; secondary outcome measures will comprise self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation.Statistical analysisData will be analysed based on intention-to-treat with a mixed effects regression model accounting for between and within-subject variations in the effects of the intervention.DiscussionThis study will contribute to the limited knowledge base regarding the effectiveness of structured group self-management support for anxiety disorders. It is expected that changes in patients’ self-management behaviour will lead to better anxiety management and, consequently, to improved patient outcomes.Trial registrationClinicalTrials.gov: NCT05124639. Prospectively registered 18 November 2021.

The comparison of self-management group education and the standard care for patients with type 2 diabetes mellitus: An updated systematic review and meta-analysis.

To investigate the efficacy of self-management group education versus the standard care for patients with type 2 diabetes mellitus (DM). An electronic search was performed in nine databases including PubMed for selecting eligible studies. Meta-analysis was used for pooling of the results. Of 3446 records screened, we included ten studies for this systematic review and meta-analysis. Regarding assessment of effectiveness, there was a significant superiority reported in the intervention group when compared to the usual/standard care (standardized mean difference [95% confidence interval] = 0.24 [0.15; 0.32]). The intervention group had a significant reduction in the levels of hemoglobin A1C (HbA1C), fasting blood glucose, low-density lipoprotein, total cholesterol, and body mass index compared to the usual/standard care (p < 0.05). Moreover, no significant difference was observed in the levels of high-density lipoprotein, systolic blood pressure (SBP), or diastolic blood pressure (DBP) between the two groups (p > 0.05). Self-management group education interventions are recommended in patients with type 2 DM for their effectiveness in different clinical aspects.

A Lifestyle Management for Arthritis Group education intervention for people with inflammatory and degenerative arthritis: An observational study.

Occupational therapy self-management groups aim to assist individuals to incorporate health-promoting behaviours and management strategies into their daily routines to promote wellbeing. The Lifestyle Management for Arthritis Group (LMAG) is a 2-h-long, occupational therapy educational-behavioural group intervention adapted from the evidence-based Lifestyle Management for Arthritis Programme (Hammond & Rayner,2013) and was delivered to inpatients with inflammatory and degenerative arthritis separately. The aim of this study was to evaluate the effectiveness of this intervention in an inpatient Rheumatology Rehabilitation setting. This was an observational study with a pretest-posttest design using multiple methods. A knowledge of joint protection survey was gathered at three intervals. In-depth semi-structured phone interviews were undertaken 6weeks post intervention. The quantitative data was analysed using IBM SPSS version 25, whilst thematic analysis was used to analyse the interviews. The results confirmed that the 36 participants who completed the study had increased joint protection knowledge immediately after LMAG and continued to retain that knowledge 6weeks post intervention. The majority of participants evaluated the intervention as excellent whilst empowerment emerged as the core concept from the qualitative analysis. These study findings suggest that the LMAG intervention can have a beneficial effect inimproving the self-management skills and confidence levels of patients with inflammatory and degenerative arthritis.

Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial

Objective To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design Feasibility randomised controlled trial. Setting Outpatient rehabilitation facility. Subjects Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.

Cost-effectiveness of Self-managed Program Versus Usual Physiotherapy Care of Patients With Knee Osteoarthritis in Nigeria

Objectives: This study aims to compare, from a patient’s perspective, the cost-effectiveness between a self-managed program and usual physiotherapy care in treating knee osteoarthritis. Methods: The study participants were assigned into two groups: group I received a weekly physiotherapy treatment plus instructions on self-management skills in goal setting, pain management, exercise, healthy eating, and dealing with fatigue (self-managed group); group II had a physiotherapy session three times a week (usual care group). The osteoarthritis cost and consequence and European quality of life-5 dimension (EQ-5D) were used to generate utility scores. The health effects measure of quality-adjusted life year (QALY) was obtained, and an incremental cost-effective ratio was calculated. Cost-effectiveness was determined by plotting a cost-effectiveness plane of incremental cost against QALY obtained. Results: After 8 weeks of intervention, the self-managed group recorded more significant improvements in pain level, function, and health-related quality of life than the usual care group. Clinical consultation costs (Mean±SD NGN [Nigerian naira]=1800±979), physiotherapy treatment costs (Mean±SD NGN=4000±00), and transportation costs (Mean±SD NGN=1,940±1,150) were less for the self-managed group than the usual care group. Imaging (x-ray) and drug costs did not differ significantly between groups. The QALYs gained over the 8-week intervention period was 0.13 for the self-management group compared to 0.11 for the usual care group. Discussion: From the patient’s perspective, a self-managed program was cost-effective and cheaper for healthcare resource use. Physiotherapists may adopt the program to reduce out-of-pocket expenses for patients with knee osteoarthritis.

Effect of self-management interventions for adults with epilepsy: a systematic review and meta-analysis.

Since there are several articles reporting self-management for adults with epilepsy, we conduct this comprehensive analysis to evaluate the clinical effects of self-management (SM) for adult patients with epilepsy. Multiple databases were searched for relevant studies, and full-text articles involved in the comparison between self-management and controls were reviewed. We analyzed the bias of the included articles. Review Manager 5.2 was then used to evaluate the heterogeneity of results in the selected articles. The forest map and sensitivity analysis were made. Eventually, eight studies involving 1,466 patients satisfied the eligibility criteria. The samples of self-management and control groups were 733 and 733 respectively. The results of heterogeneity testing suggested that self-management had higher indicators than the control group, including Quality of Life Scale for Patients with Epilepsy (QOLIE-31) [the overall mean difference was 2.76 with 95% CI (0.24, 5.29). The P value of overall effect was 0.03, I2=68%], Satisfaction With Life Scale (SWLS) [MD =0.44, 95% CI: (0.22, 0.65), P<0.0001], fixed effect model and the included studies were of low homogeneity (P=0.93, I2=0%), and Epilepsy Self-Management Scale (ESMS) [MD =0.13, 95% CI: (-0.02, 0.23), P=0.02, fixed effect model with insignificant heterogeneity I2=13%]. The results of our study suggested self-management might be an effective intervention for adult patients with epilepsy.

A Cross-Provider Healthcare Management Program for Musculoskeletal Disorders: Results of a Randomized Controlled Trial in 22 German Companies.

Musculoskeletal disorders (MSDs) are among the most common cause for reduced work capacity and sick leave. Workplace health promotion programs are often neither tailored to the workplace nor the individual needs of the employees. To counteract lacking intersectional care, this four-year randomized controlled trial (RCT) aimed to investigate the effects of modular coordinating case management (treatment group) compared to supported self-management (control group) on MSD specific sick leave days (routine data), workability (WAI), self-efficacy (self-efficacy scale), and pain (German pain questionnaire, GPQ). The study network comprised 22 companies, 15 company health insurance funds, and 12 pension funds in Germany. Overall, 852 participants (Module A/early intervention: n = 651, Module B/rehabilitation: n = 190, Module C/reintegration: n = 10) participated. Both groups achieved fewer sick leave days, higher workability, and less pain (p < 0.0001) at follow-up compared to baseline. At follow-up, the coordinating case management group showed fewer disability days (GPQ), lower disability scores (GPQ), and lower pain intensities (GPQ) than the supported self-management group (p < 0.05), but no superiority regarding MSD specific sick leave days, workability, nor self-efficacy. Module A showed more comprehensive differences. The accompanying process evaluation shows barriers and facilitators for the implementation of the program, especially in a RCT setting.

Self-management: A comprehensive approach to improve quality of life among people living with HIV in Indonesia.

People living with HIV (PLWH) today have to deal with a chronic condition that requires efficient self-management due to increased longevity. Self-management interventions have been shown to improve physical and psychological symptoms as well as clinical results in chronic diseases. However, few studies have investigated the effect of self-management on quality of life (QOL) among PLWH in Indonesia. To examine the effect of a self-management program on QOL among PLWH in Indonesia. This was a quasi-experimental study with a comparison group in a general hospital in Jakarta, Indonesia. Of the 114 recruited PLWH, 57 were assigned to the intervention group and 57 to the comparison group. The self-management group attended a four-week program workshop. The intervention consisted of five sessions: need assessment and goal setting, maintaining a healthy lifestyle, educational participation to increase communication and self-esteem, and evaluation. The comparison group received standard educational material throughout the leaflet regarding HIV prevention. The post-test assessment was conducted immediately after intervention (T1) and two months (T2) after the intervention in both groups. QOL was measured using the World Health Organization Quality of Life (WHOQOL)-HIV brief Bahasa version. The estimations were obtained using fixed-effect regressions. The differences between T0, T1, and T2 for the intervention and comparison groups were evaluated and compared using the DI Differences method (DID). The self-management program improved outcomes relative to the comparison group at T1: 1) overall QOL score increased 8.7% (95% CI 0.021-0.149), 2) physical domain saw a modest increased 8.8% (95% CI 0.017-0.125), 3) psychological domain increased 23.5 % (95% CI 0.085-0.689), and 4) environmental domain showed a modest increase of 18.7% (95% CI 0.053-0.371). At T2, the total QOL score and the physical, psychological, and environmental dimensions were significantly improved compared to the comparison group. The self-management program appears to improve the QOL of the life of PLWH. Nurses are advised to provide PLWH with self-management training. Future research on self-management intervention would need to be refined further to ensure that each community achieves consistent intervention outcomes.

Caring for children with Congenital Zika Syndrome: The unmet needs of mothers in Southern Colombia

ABSTRACT In Latin America, the Zika virus (ZIKV) epidemic of 2015–2016 resulted in children being born with a spectrum of neurological disorders called Congenital Zika Syndrome (CZS). Women are the primary caregivers of those children. The objective of the study was to identify the perceived needs of women to care for their children with CZS in Southern Colombia. In 2019, a qualitative ethnographic study was conducted in southern Colombia, including 21 women belonging to a self-managed support group and who had prenatal ZIKV between 2015 and 2016 and, as a consequence, their children were born with CZS. Three discussion groups and six semi-structured interviews were conducted and analyzed through qualitative content analysis. Three main perceived needs to care for their children were identified: knowledge and skills to provide the complex care their children require and for which they did not feel prepared, economic and social support. This study showed that women face unmet needs when caring for their children with CZS, especially regarding social support. Therefore, it is urgent to generate public policies and intervention strategies for professionals to support these women in order to meet not only the needs of their children but also their own.

Evaluation of diabetes self-management education in geriatrics with type 2 diabetes in Turkey.

This study was conducted to evaluate the diabetes education efficiency of individuals over 65 years old in Turkey, which has the highest prevalence of diabetes in Europe. We retrospectively evaluated 320 patients who attended Turkey diabetes self-management group education program (TDSMEP) between 2016 and 2020 in a secondary hospital. Participants who have been followed up for a maximum of 9 months are grouped as over 65 years old and under. Of the 320 patients, 114 formed the geriatric group and 206 the non-geriatric group. After the training, the number of patients who had HbA1c≤7% increased significantly in both the geriatric (28.1-45.6%) and non-geriatric (19.9-42.2%) (P=0.001) groups. After the training, similar HbA1c goals were achieved in the geriatric and non-geriatric groups. The most significant HbA1c decrease was observed at the 3rd month of follow-up and remained stable until the 9th month. In logistic regression analysis, the factors affecting HbA1c failure (HbA1c>7%) after training in the geriatric group were long diabetes duration (OR=1.07, 95% CI: 1.02-1.13, P=0.01), high basal HbA1c levels (OR=1.31, 95% CI: 1.03-1.67, P=0.03), and low education level (OR=3.88, 95% CI: 1.54-9.76, P=0.001). This is the first study to evaluate the effectiveness of TDSMEP for geriatric individuals whose HbA1c≤7% increased from 28% to 45.6% during follow-up after the training. TDSMEP is recommended for all adult age groups, regardless of age range.

Promoting physical activity with self-management support for those with multimorbidity: a randomised controlled trial.

BackgroundTargeted self-management programmes may improve health and increase physical activity (PA) in people with multimorbidity.AimTo investigate the impact of a structured, theoretically driven, self-management group education programme on habitual PA levels in people with multimorbidity.Design and settingIndividually randomised controlled trial with 12-month follow-up, involving nine primary care practices in Leicestershire, UK.MethodIn total, 353 adults with multimorbidity (age 67.8 years [±9 years], 161 male sex) were randomised to intervention (n = 180) or control (n = 173) groups. Intervention participants were invited to attend four group-based self-management sessions, centred primarily on increasing PA, and received motivational text-message support. The primary outcome measure was change in overall volume (time and intensity) of daily PA at 12 months, as measured by the GENEActiv wrist-worn accelerometer device.ResultsAt baseline, the total sample achieved 22 min of moderate–vigorous intensity PA per day (mean/participant). At 12 months, in the complete-case analysis, a reduction in daily mean PA volume was seen in the intervention group relative to control (−0.80 milligravity [m g]; 95% confidence interval [CI] = −1.57 to −0.03; P = 0.04). Reductions were also seen in the intervention group in time spent in moderate–vigorous PA (−3.86 min per day; 95% CI= −6.70 to −1.03; P = 0.008) and time spent at an intensity equivalent to a slow walk (−4.66 min per day; 95% CI = −8.82 to −0.51; P = 0.028). However, the per-protocol analysis (excluding participants who did not attend at least one education session) found no between-group differences in overall daily PA at 12 months (−0.65 mg; 95% CI = −1.46 to 0.15; P = 0.11).ConclusionThe self-management programme elicited a slight reduction in PA levels in people with multimorbidity. Future research should identify and target subgroups of those with multimorbidity in greatest need of PA promotion in order to maximise potential capacity for benefit, and also focus on refining the intervention in order to increase efficacy in increasing PA.

Efficacy of web-based self-management interventions for depressive symptoms: a meta-analysis of randomized controlled trials

BackgroundThe incidence of depression is increasing worldwide. Depression can lead to poor physical health and even suicide. However, in high-income countries, only about 50% of the people with depression receive appropriate therapy, and the detection rate of depression in low- and middle-income countries is relatively lower. Web-based self-management enables remote treatment and solves the problem of insufficient psychological treatment resources. Many past studies have evaluated the effectiveness of web-based self-management of depression, but there has been no synthesis of evidence. Therefore, this study conducted a meta-analysis of the effectiveness of web-based self-management for depressive symptoms.MethodSix electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, CINAHL, and PsycINFO) were searched in September 2020. All literature referring to the effects of web-based self-management on depression were shortlisted by performing the medical subject headings (MeSH) search combined with a text word search.ResultsA total of 18 eligible randomized controlled trials were identified, and the results from 3055 participants were consolidated. The web-based self-management group exhibited a greater reduction in depressive symptoms than the control group (g = − 0.46; 95% CI: 0.62,0.30), and there was no evidence of publication bias. Subgroup analysis revealed that patients with moderate-to-severe depression benefited from web-based self-management interventions. In terms of interventions, those based on cognitive behavioral therapy (CBT) were highly effective. We noted that the longer the intervention time, the better was the improvement in the status of depression. Furthermore, it was established that participants who communicated with therapists and showed greater adherence to the intervention experienced significant improvement in their symptoms. The results of the intervention group were better than those of the waiting-list, treatment-as-usual, and online psychoeducation groups.ConclusionsWeb-based self-management is a promising therapy for depression. Future research should aim to refine these aspects of the intervention to achieve a beneficial impact.

Mixed methods evaluation of a self-management group programme for patients with neuromuscular disease and chronic fatigue

ObjectiveTo obtain insight into experiences of patients with a neuromuscular disease and chronic fatigue and their healthcare professionals regarding content and delivery of a multidisciplinary outpatient self-management group programme to...

The challenge of sustainability: Long-term results from the Fifty-Fifty peer group-based intervention in cardiovascular risk factors

The Fifty-Fifty trial demonstrated that a peer-group-based intervention was able to improve healthy behaviors in individuals with cardiovascular (CV) risk factors immediately post-intervention. To determine the long-term sustainability of a one-year peer-group-based intervention focused on CV health and behavior. A total of 543 adults aged 25 to 50 years with at least 1 CV risk factor were screened and recruited, received initial training through workshops, and were then randomized 1:1 to a peer-group-based intervention group (IG) or a self-management control group (CG) for 12 months. At a median of 52 months from baseline, 321 participants were re-assessed (~60% retention). The primary outcome was the mean change in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco use (Fuster-BEWAT score [FBS], range 0-15). Intervention effects were assessed using linear-mixed effects models. The mean age of retained participants was 48.0 years (SD: 5.4), and 73% were female. Consistent with previous results, the change of overall FBS was significantly greater in the IG than in the CG at 12-month follow-up (between-group difference, 0.60 points; 95% CI, 0.08-1.12; P=.025). Assessment of long-term sustainability (52-month follow-up) showed that there were no between-group differences in the mean overall FBS (IG mean score, 8.52; 95% CI, 7.97-9.07 vs CG mean score, 8.51; 95% CI, 7.93-9.10; P=.972) or in the change of overall FBS from screening (IG mean change, 0.64; 95% CI, 0.00-1.28; CG mean change, 0.46; 95% CI, -0.20-1.12; P=.497). A one-year peer-group-based intervention showed favorable results at immediate post-intervention but did not demonstrate significant differences between the IG and CG at 52 months. Combination of an initial training period (workshops) with the maintenance of peer-support groups or other re-intervention strategies may be required to achieve sustained effects on healthy behaviors. ClinicalTrials.gov identifier NCT02367963. Registered (https://clinicaltrials.gov/show/NCT02367963).

Self-management on heart failure: A meta-analysis

Background and aimsHeart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. MethodsThe research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. ResultsEight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. ConclusionSelf-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).

Long-term effectiveness of group-based diabetes self-management on glycosylated haemoglobin for people with type 2 diabetes in community: a protocol of systematic review and meta-analysis

IntroductionThe rapid rise in the prevalence of diabetes has a negative impact on patients’ quality of life. Diabetes self-management group education is cost-effective and efficient for patients to control blood...