title: Meta-analysis: chronic disease self-management programs for older adults.
abstract: BACKGROUND
  Although enthusiasm is growing for self-management programs for chronic conditions, there are conflicting data regarding their effectiveness and no agreement on their essential components.
  
  
  OBJECTIVE
  To assess the effectiveness and essential components of self-management programs for hypertension, osteoarthritis, and diabetes mellitus.
  
  
  METHODS
  The authors searched multiple sources dated through September 2004, including the Cochrane Library, MEDLINE, PsycINFO, and Nursing and Allied Health databases, and bibliographies of 87 previous reviews.
  
  
  METHODS
  Randomized trials that compared outcomes of self-management interventions with a control or with usual care for diabetes mellitus, osteoarthritis, or hypertension; outcomes included hemoglobin A1c level, fasting blood glucose level, weight, blood pressure, pain, or function.
  
  
  METHODS
  Two reviewers independently identified trials and extracted data regarding whether the intervention used tailored adjustments to meet individual patient needs, a group setting, feedback, and psychological services, and whether the intervention was provided by the patient's usual physician.
  
  
  RESULTS
  Of 780 studies screened, 53 studies contributed data to the random-effects meta-analysis (26 diabetes studies, 14 osteoarthritis studies, and 13 hypertension studies). Self-management interventions led to a statistically and clinically significant pooled effect size of -0.36 (95% CI, -0.52 to -0.21) for hemoglobin A1c, equivalent to a reduction in hemoglobin A1c level of about 0.81%. Self-management interventions decreased systolic blood pressure by 5 mm Hg (effect size, -0.39 [CI, -0.51 to -0.28]) and decreased diastolic blood pressure by 4.3 mm Hg (effect size, -0.51 [CI, -0.73 to -0.30]). Pooled effects of self-management interventions were statistically significant but clinically trivial for pain and function outcomes for osteoarthritis. No consistent results supported any of the 5 characteristics examined as essential for program success.
  
  
  CONCLUSIONS
  Studies had variable quality, and possible publication bias was evident.
  
  
  CONCLUSIONS
  Self-management programs for diabetes mellitus and hypertension probably produce clinically important benefits. The elements of the programs most responsible for benefits cannot be determined from existing data, and this inhibits specification of optimally effective or cost-effective programs. Osteoarthritis self-management programs do not appear to have clinically beneficial effects on pain or function.
authors.affiliation: Southern California Evidence-based Practice Center, RAND Health Division, Santa Monica, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.forename: Walter
authors.initials: W
authors.lastname: Mojica
authors.forename: Margaret
authors.initials: M
authors.lastname: Maglione
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Lara
authors.initials: L
authors.lastname: Hilton
authors.forename: Shannon
authors.initials: S
authors.lastname: Rhodes
authors.forename: Paul
authors.initials: P
authors.lastname: Shekelle
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D010003:Osteoarthritis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin