title: Self-management support for moderate-to-severe chronic obstructive pulmonary disease: a pilot randomised controlled trial.
abstract: BACKGROUND
  Better self management could improve quality of life (QoL) and reduce hospital admissions in chronic obstructive pulmonary disease (COPD), but the best way to promote it remains unclear.
  
  
  OBJECTIVE
  To explore the feasibility, effectiveness and cost  effectiveness of a novel, layperson-led, theoretically driven COPD self-management support programme.
  
  
  METHODS
  Pilot randomised controlled trial in one UK primary care trust area.
  
  
  METHODS
  Patients with moderate to severe COPD were identified  through primary care and randomised 2:1 to the 7-week-long, group intervention or usual care. Outcomes at baseline, 2, and 6 months included self-reported health, St George's Respiratory Questionnaire (SGRQ), EuroQol, and exercise.
  
  
  RESULTS
  Forty-four per cent responded  to GP invitation, 116 were randomised: mean (standard deviation [SD]) age 69.5 (9.8) years, 46% male, 78% had unscheduled COPD care in the previous year. Forty per cent of intervention patients completed the course; 35% attended no sessions; and 78% participants completed the 6-month follow-up  questionnaire. Results suggest that the intervention may increase both QoL (mean EQ-5D change 0.12 (95% confidence interval [CI] = -0.02 to 0.26) higher, intervention versus control) and exercise levels, but not SGRQ score. Economic analyses suggested that with thresholds of £20  000 per quality-adjusted life-year gained, the intervention is likely to be cost-effective.
  
  
  CONCLUSIONS
  This intervention has good potential to meet the UK National Institute for Health and Clinical Excellence criteria for cost effectiveness, and further research is warranted.  However, to make a substantial impact on COPD self-management, it will also be necessary to explore other ways to enable patients to access self-management education.
authors.affiliation: Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK. s.j.c.taylor@qmul.ac.uk
authors.forename: Stephanie J C
authors.initials: SJ
authors.lastname: Taylor
authors.forename: Ratna
authors.initials: R
authors.lastname: Sohanpal
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Bremner
authors.forename: Angela
authors.initials: A
authors.lastname: Devine
authors.forename: David
authors.initials: D
authors.lastname: McDaid
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Fernández
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Griffiths
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012129:Respiratory Function Tests; D012648:Self Care / Q000191:economics / Q000379:methods*; D020377:Self Efficacy; D011795:Surveys and Questionnaires