Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis

Nini H. Jonkman, Heleen Westland, Jaap C.A. Trappenburg, Rolf H.H. Groenwold, Erik W.M.A. Bischoff, Jean Bourbeau, Christine E. Bucknall, David Coultas, Tanja W. Effing, Michael J. Epton, Frode Gallefoss, Judith Garcia-Aymerich, Suzanne M. Lloyd, Evelyn M. Monninkhof, Huong Q. Nguyen, Job van der Palen, Kathryn L. Rice, Maria Sedeno, Stephanie J.C. Taylor, Thierry Troosters & 3 others Nicholas A. Zwar, Arno W. Hoes, Marieke J. Schuurmans

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Abstract

Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

Original languageEnglish
Pages (from-to)2063-2074
Number of pages12
JournalInternational Journal of COPD
Volume11
Issue number1
DOIs
Publication statusPublished - 31 Aug 2016
Externally publishedYes

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Self Care
Chronic Obstructive Pulmonary Disease
Meta-Analysis
Hospitalization
Confidence Intervals
Quality of Life
Mortality
Self Efficacy
Body Mass Index
Research Personnel
Lung

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Jonkman, N. H., Westland, H., Trappenburg, J. C. A., Groenwold, R. H. H., Bischoff, E. W. M. A., Bourbeau, J., ... Schuurmans, M. J. (2016). Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis. International Journal of COPD, 11(1), 2063-2074. https://doi.org/10.2147/COPD.S107884
Jonkman, Nini H. ; Westland, Heleen ; Trappenburg, Jaap C.A. ; Groenwold, Rolf H.H. ; Bischoff, Erik W.M.A. ; Bourbeau, Jean ; Bucknall, Christine E. ; Coultas, David ; Effing, Tanja W. ; Epton, Michael J. ; Gallefoss, Frode ; Garcia-Aymerich, Judith ; Lloyd, Suzanne M. ; Monninkhof, Evelyn M. ; Nguyen, Huong Q. ; van der Palen, Job ; Rice, Kathryn L. ; Sedeno, Maria ; Taylor, Stephanie J.C. ; Troosters, Thierry ; Zwar, Nicholas A. ; Hoes, Arno W. ; Schuurmans, Marieke J. / Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis. In: International Journal of COPD. 2016 ; Vol. 11, No. 1. pp. 2063-2074.
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title = "Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis",
abstract = "Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95{\%} confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95{\%} CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95{\%} CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.",
author = "Jonkman, {Nini H.} and Heleen Westland and Trappenburg, {Jaap C.A.} and Groenwold, {Rolf H.H.} and Bischoff, {Erik W.M.A.} and Jean Bourbeau and Bucknall, {Christine E.} and David Coultas and Effing, {Tanja W.} and Epton, {Michael J.} and Frode Gallefoss and Judith Garcia-Aymerich and Lloyd, {Suzanne M.} and Monninkhof, {Evelyn M.} and Nguyen, {Huong Q.} and {van der Palen}, Job and Rice, {Kathryn L.} and Maria Sedeno and Taylor, {Stephanie J.C.} and Thierry Troosters and Zwar, {Nicholas A.} and Hoes, {Arno W.} and Schuurmans, {Marieke J.}",
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month = "8",
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doi = "10.2147/COPD.S107884",
language = "English",
volume = "11",
pages = "2063--2074",
journal = "International Journal of COPD",
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Jonkman, NH, Westland, H, Trappenburg, JCA, Groenwold, RHH, Bischoff, EWMA, Bourbeau, J, Bucknall, CE, Coultas, D, Effing, TW, Epton, MJ, Gallefoss, F, Garcia-Aymerich, J, Lloyd, SM, Monninkhof, EM, Nguyen, HQ, van der Palen, J, Rice, KL, Sedeno, M, Taylor, SJC, Troosters, T, Zwar, NA, Hoes, AW & Schuurmans, MJ 2016, 'Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis' International Journal of COPD, vol. 11, no. 1, pp. 2063-2074. https://doi.org/10.2147/COPD.S107884

Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis. / Jonkman, Nini H.; Westland, Heleen; Trappenburg, Jaap C.A.; Groenwold, Rolf H.H.; Bischoff, Erik W.M.A.; Bourbeau, Jean; Bucknall, Christine E.; Coultas, David; Effing, Tanja W.; Epton, Michael J.; Gallefoss, Frode; Garcia-Aymerich, Judith; Lloyd, Suzanne M.; Monninkhof, Evelyn M.; Nguyen, Huong Q.; van der Palen, Job; Rice, Kathryn L.; Sedeno, Maria; Taylor, Stephanie J.C.; Troosters, Thierry; Zwar, Nicholas A.; Hoes, Arno W.; Schuurmans, Marieke J.

In: International Journal of COPD, Vol. 11, No. 1, 31.08.2016, p. 2063-2074.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Do self-management interventions in COPD patients work and which patients benefit most? An individual patient data meta-analysis

AU - Jonkman, Nini H.

AU - Westland, Heleen

AU - Trappenburg, Jaap C.A.

AU - Groenwold, Rolf H.H.

AU - Bischoff, Erik W.M.A.

AU - Bourbeau, Jean

AU - Bucknall, Christine E.

AU - Coultas, David

AU - Effing, Tanja W.

AU - Epton, Michael J.

AU - Gallefoss, Frode

AU - Garcia-Aymerich, Judith

AU - Lloyd, Suzanne M.

AU - Monninkhof, Evelyn M.

AU - Nguyen, Huong Q.

AU - van der Palen, Job

AU - Rice, Kathryn L.

AU - Sedeno, Maria

AU - Taylor, Stephanie J.C.

AU - Troosters, Thierry

AU - Zwar, Nicholas A.

AU - Hoes, Arno W.

AU - Schuurmans, Marieke J.

PY - 2016/8/31

Y1 - 2016/8/31

N2 - Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

AB - Background: Self-management interventions are considered effective in patients with COPD, but trials have shown inconsistent results and it is unknown which patients benefit most. This study aimed to summarize the evidence on effectiveness of self-management interventions and identify subgroups of COPD patients who benefit most. Methods: Randomized trials of self-management interventions between 1985 and 2013 were identified through a systematic literature search. Individual patient data of selected studies were requested from principal investigators and analyzed in an individual patient data meta-analysis using generalized mixed effects models. Results: Fourteen trials representing 3,282 patients were included. Self-management interventions improved health-related quality of life at 12 months (standardized mean difference 0.08, 95% confidence interval [CI] 0.00–0.16) and time to first respiratory-related hospitalization (hazard ratio 0.79, 95% CI 0.66–0.94) and all-cause hospitalization (hazard ratio 0.80, 95% CI 0.69–0.90), but had no effect on mortality. Prespecified subgroup analyses showed that interventions were more effective in males (6-month COPD-related hospitalization: interaction P=0.006), patients with severe lung function (6-month all-cause hospitalization: interaction P=0.016), moderate self-efficacy (12-month COPD-related hospitalization: interaction P=0.036), and high body mass index (6-month COPD-related hospitalization: interaction P=0.028 and 6-month mortality: interaction P=0.026). In none of these subgroups, a consistent effect was shown on all relevant outcomes. Conclusion: Self-management interventions exert positive effects in patients with COPD on respiratory-related and all-cause hospitalizations and modest effects on 12-month health-related quality of life, supporting the implementation of self-management strategies in clinical practice. Benefits seem similar across the subgroups studied and limiting self-management interventions to specific patient subgroups cannot be recommended.

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U2 - 10.2147/COPD.S107884

DO - 10.2147/COPD.S107884

M3 - Article

VL - 11

SP - 2063

EP - 2074

JO - International Journal of COPD

JF - International Journal of COPD

SN - 1176-9106

IS - 1

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