title: Supported self-management for patients with COPD who have recently been discharged from hospital: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Although many hospitals promote self-management to chronic obstructive pulmonary disease (COPD) patients post discharge from hospital, the clinical effectiveness of this is unknown. We undertook a systematic review of the evidence as part of a Health Technology Assessment review.
  
  
  METHODS
  A comprehensive search strategy with no language restrictions was conducted across relevant databases from inception to May 2012. Randomized controlled trials of patients with COPD, recently discharged from hospital after an acute exacerbation and comparing a self-management intervention with control, usual care or other intervention were included. Study selection, data extraction, and risk of bias assessment were undertaken by two reviewers independently.
  
  
  RESULTS
  Of 13,559 citations, 836 full texts were reviewed with nine randomized controlled trials finally included in quantitative syntheses. Interventions were heterogeneous. Five trials assessed highly supported multi-component interventions and four trials were less supported with fewer contacts with health care professionals and mainly home-based interventions. Total sample size was 1,466 (range 33-464 per trial) with length of follow-up 2-12 months. Trials varied in quality; poor patient follow-up and poor reporting was common. No evidence of effect in favor of self-management support was observed for all-cause mortality (pooled hazard ratio =1.07; 95% confidence interval [0.74 to 1.55]; I (2)=0.0%, [n=5 trials]). No clear evidence of effect on all-cause hospital admissions was observed (hazard ratio 0.88 [0.61, 1.27] I (2)=66.0%). Improvements in St George's Respiratory Questionnaire score were seen in favor of self-management interventions (mean difference =3.84 [1.29 to 6.40]; I (2)=14.6%), although patient follow-up rates were low.
  
  
  CONCLUSIONS
  There is insufficient evidence to support self-management interventions post-discharge. There is a need for good quality primary research to identify effective approaches.
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Saimma
authors.initials: S
authors.lastname: Majothi
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Nicola R
authors.initials: NR
authors.lastname: Heneghan
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Price
authors.affiliation: Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Riley
authors.affiliation: Queen Elizabeth Hospital Research Laboratories, Birmingham, UK.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Turner
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bayliss
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
authors.affiliation: Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Singh
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Peymané
authors.initials: P
authors.lastname: Adab
authors.affiliation: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Fitzmaurice
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Jordan
mesh_terms: D006699:Home Care Services; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D010351:Patient Discharge; D010359:Patient Readmission; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: chronic obstructive pulmonary disease; post-discharge; self-management support; systematic review