Chest
Volume 147, Issue 3, March 2015, Pages 646-661
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Original Research: COPD
Self-Management Following an Acute Exacerbation of COPD: A Systematic Review

https://doi.org/10.1378/chest.14-1658Get rights and content

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.

Section snippets

Search Strategy

The set of terms included: “chronic obstructive” OR COPD OR emphysema OR bronchitis AND exacerbat* OR hospital* AND education OR self-manag* OR “self manag” OR self-care* OR “self car*” OR “management plan” OR “management prog*” OR “action plan” OR “integrated care”. An extensive search was conducted in August 2013, and updated in March 2014, of electronic databases including PubMed, AMED, CINAHL, British Nursing Index (BNI), PsychINFO, EMBASE, and MEDLINE from inception to present. The

Identification of Papers

All papers were identified during the first search in August 2013. An updated search using the same search terms and databases did not identify any new papers. The initial database produced 2,683 titles and abstracts; after duplicates were removed, 1,106 remained: of these, 1,088 articles were excluded during the initial screening. Full text was obtained for 18 papers, of which 11 studies were excluded following appraisal with reasons for exclusion documented inFigure 1.15, 16, 17, 18, 19, 20,

Discussion

This is the first systematic review examining the effect of SM interventions, in the absence of supervised exercise, delivered immediately post-AECOPD. The SM interventions included in the studies were delivered in-hospital and in patients' homes by nurses. All studies included action plans for the early recognition of AE, as well as disease-specific education, but strategies to teach SM skills were limited. The health outcomes assessed varied widely across studies, often in the absence of

Acknowledgments

Author contributions: R. G. is the guarantor of the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis. S. L. H. and T. J.-F. contributed to study conception and design, searched literature, extracted and interpreted data, wrote the manuscript, and approved the final version of the manuscript; D. B. and R. S. G. contributed to study conception and design, interpreted data, provided critical revisions that were important for intellectual

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  • Cited by (0)

    Drs Harrison and Janaudis-Ferreira share joint first authorship.

    FUNDING/SUPPORT: Dr Brooks holds a Canada research chair.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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