title: Identifying components of self-management interventions that improve health-related quality of life in chronically ill patients: Systematic review and meta-regression analysis.
abstract: To quantify diversity in components of self-management interventions and explore which components are associated with improvement in health-related quality of life (HRQoL) in patients with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), or type 2 diabetes mellitus (T2DM).
  
  
  
  Systematic literature search was conducted from January 1985 through June 2013. Included studies were randomised trials in patients with CHF, COPD, or T2DM, comparing self-management interventions with usual care, and reporting data on disease-specific HRQoL. Data were analysed with weighted random effects linear regression models.
  
  
  
  47 trials were included, representing 10,596 patients. Self-management interventions showed great diversity in mode, content, intensity, and duration. Although self-management interventions overall improved HRQoL at 6 and 12 months, meta-regression showed counterintuitive negative effects of standardised training of interventionists (SMD=-0.16, 95% CI: -0.31 to -0.01) and peer interaction (SMD=-0.23, 95% CI: -0.39 to 0.06) on HRQoL at 6 months.
  
  
  
  Self-management interventions improve HRQoL at 6 and 12 months, but interventions evaluated are highly heterogeneous. No components were identified that favourably affected HRQoL. Standardised training and peer interaction negatively influenced HRQoL, but the underlying mechanism remains unclear.
  
  
  
  Future research should address process evaluations and study response to self-management on the level of individual patients.
authors: Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands. Electronic address: n.jonkman@umcutrecht.nl.
authors: Nini H
authors: NH
authors: Jonkman
authors: Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands.
authors: Marieke J
authors: MJ
authors: Schuurmans
authors: Julius Center for Health Sciences and Primary Care, HP Str. 6.131, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands.
authors: Rolf H H
authors: RHH
authors: Groenwold
authors: Julius Center for Health Sciences and Primary Care, HP Str. 6.131, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands.
authors: Arno W
authors: AW
authors: Hoes
authors: Department of Rehabilitation, Nursing Science and Sports Medicine, HP W01.121, University Medical Center Utrecht, PO 85500, NL-3508 GA, Utrecht, the Netherlands.
authors: Jaap C A
authors: JCA
authors: Trappenburg
mesh_terms: D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D006304:Health Status; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D012648:Self Care / Q000379:methods*
keywords: Chronic heart failure; Chronic obstructive pulmonary disease; Complex interventions; Meta-regression; Self-management; Systematic review; Type 2 diabetes mellitus