title: Characteristics of effective self-management interventions in patients with COPD: individual patient data meta-analysis.
abstract: It is unknown whether heterogeneity in effects of self-management interventions in patients with chronic obstructive pulmonary disease (COPD) can be explained by differences in programme characteristics. This study aimed to identify which characteristics of COPD self-management interventions are most effective.Systematic search in electronic databases identified randomised trials on self-management interventions conducted between 1985 and 2013. Individual patient data were requested for meta-analysis by generalised mixed effects models.14 randomised trials were included (67% of eligible), representing 3282 patients (75% of eligible). Univariable analyses showed favourable effects on some outcomes for more planned contacts and longer duration of interventions, interventions with peer contact, without log keeping, without problem solving, and without support allocation. After adjusting for other programme characteristics in multivariable analyses, only the effects of duration on all-cause hospitalisation remained. Each month increase in intervention duration reduced risk of all-cause hospitalisation (time to event hazard ratios 0.98, 95% CI 0.97-0.99; risk ratio (RR) after 6 months follow-up 0.96, 95% CI 0.92-0.99; RR after 12 months follow-up 0.98, 95% CI 0.96-1.00).Our results showed that longer duration of self-management interventions conferred a reduction in all-cause hospitalisations in COPD patients. Other characteristics are not consistently associated with differential effects of self-management interventions across clinically relevant outcomes.
authors.affiliation: Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands n.jonkman@umcutrecht.nl.
authors.forename: Nini H
authors.initials: NH
authors.lastname: Jonkman
authors.affiliation: Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Westland
authors.affiliation: Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jaap C A
authors.initials: JC
authors.lastname: Trappenburg
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Rolf H H
authors.initials: RH
authors.lastname: Groenwold
authors.affiliation: Dept of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Erik W M A
authors.initials: EW
authors.lastname: Bischoff
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, Dept of Medicine, McGill University Health Center, McGill University, Montreal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.affiliation: Dept of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Bucknall
authors.affiliation: Veterans Administration Portland Health Care System and Oregon Health & Science University, Portland, OR, USA.
authors.forename: David
authors.initials: D
authors.lastname: Coultas
authors.affiliation: Dept of Respiratory Medicine, Repatriation General Hospital, Adelaide, Australia.
authors.forename: Tanja W
authors.initials: TW
authors.lastname: Effing
authors.affiliation: Canterbury District Health Board, Respiratory Services, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Epton
authors.affiliation: Dept of Pulmonary Medicine, Sorlandet Hospital, Kristiansand, Norway.
authors.forename: Frode
authors.initials: F
authors.lastname: Gallefoss
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Garcia-Aymerich
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Lloyd
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Monninkhof
authors.affiliation: Dept of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.affiliation: Dept of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands Department of Clinical Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care Service and University of Minnesota, Minneapolis, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, Dept of Medicine, McGill University Health Center, McGill University, Montreal, Canada.
authors.forename: Maria
authors.identifier: 0000-0001-7108-1512
authors.initials: M
authors.lastname: Sedeno
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors.forename: Stephanie J C
authors.initials: SJ
authors.lastname: Taylor
authors.affiliation: Dept of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Troosters
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Zwar
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Dept of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000534:rehabilitation*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D000073278:Self-Management / Q000379:methods*