title: Self-management following an acute exacerbation of COPD: a systematic review.
abstract: BACKGROUND
  Self-management (SM) reduces hospital admissions in patients with stable COPD. However, its role immediately post-acute exacerbation (AE) is unclear. The objectives of this review were to describe SM interventions delivered immediately following an AE of COPD (AECOPD) and to conduct a systematic review with meta-analysis of its impact on health-care utilization and health outcomes.
  
  
  METHODS
  Randomized controlled trials reporting on SM interventions delivered during hospitalization for an AECOPD or within 1 month of hospital discharge were included. Seven articles were identified. Data were extracted and assessed for quality by two researchers.
  
  
  RESULTS
  By definition, all interventions included action plans, education, and at least two SM skills. Nurses were responsible for providing all SM interventions. The delivery and follow-up periods varied widely. At 12 months, there were no significant differences between those who completed the SM intervention and control subjects in the number of patients readmitted to hospital (P = .38), or in health-related quality of life (P = .27). No effects were found on rate of mortality, depressive symptoms, primary care usage, or exercise capacity. Minimal effects were found on self-efficacy, anxiety symptoms, and health promoting behavior. SM was associated with positive effects on knowledge and management of an AECOPD.
  
  
  CONCLUSIONS
  SM interventions delivered immediately post-AE vary widely and outcome measures are inconsistent, making it difficult to draw strong recommendations regarding its effectiveness. The evaluation of SM interventions, delivered by trained health-care professionals to selected patients and which offer structured follow-up, appears necessary.
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre. Electronic address: samantha.harrison@westpark.org.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Harrison
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Tania
authors.initials: T
authors.lastname: Janaudis-Ferreira
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.affiliation: Department of Respiratory Medicine, West Park Healthcare Centre, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Desveaux
authors.affiliation: West Park Healthcare Centre, Department of Physical Therapy, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Goldstein
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012648:Self Care; D016896:Treatment Outcome