Detailed Search Results
| Author/Association: | Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, Rhodes S, Shekelle P |
| Title: | Meta-analysis: chronic disease self-management programs for older adults [with consumer summary] |
| Source: | Annals of Internal Medicine 2005 Sep 20;143(6):427-438 |
| Method: | systematic review |
| Method Score: | This is a systematic review. Systematic reviews are not rated. |
| Consumer Summary: | WHAT IS THE PROBLEM AND WHAT IS KNOWN ABOUT IT SO FAR: Arthritis, diabetes, and high blood pressure are chronic diseases of older adults that can be treated but not cured. Drugs can help to improve symptoms and to slow the progression of these diseases. However, patients who know more about their disease often do better than those who rely on drug therapy alone. Patients who work to make themselves healthy (for example, by exercising regularly or by losing weight) also do better. Health providers sometimes develop formal programs to teach patients with chronic disorders what they need to know and do to make their health as good as it can be. These programs are called self-management programs because patients are taught to manage more of their health themselves. WHY DID THE RESEARCHERS DO THIS PARTICULAR STUDY: To see whether self-management programs improved the health of older patients with arthritis, diabetes, and high blood pressure. HOW WAS THE STUDY DONE: The researchers searched medical literature to find published research about self-management programs for arthritis, diabetes, and high blood pressure. They looked for studies that had randomly assigned patients to receive self-management programs or to receive routine health care only. The researchers defined self-management interventions as programs that helped patients actively participate in monitoring their conditions or in decisions related to managing their conditions. They assessed whether each program involved the following: tailoring to individual patients, delivery in a group setting, delivery by the patient's usual physician, feedback, and psychological services. Then, using a technique called meta-analysis, the researchers combined the results of similar studies and explored whether certain elements of the programs were associated with better outcomes. WHAT DID THE RESEARCHERS FIND: The researchers found 53 studies that evaluated the effect of self-management programs on chronic disease. They found that, compared with usual care, self-management programs improved glucose and blood pressure control in older adults with diabetes and high blood pressure. Self-management programs offered only minimal improvement of pain and physical function in older adults with arthritis. The researchers could not identify particular elements of programs that were consistently associated with success. WHAT ARE THE LIMITATIONS OF THE STUDY: The researchers found evidence that some research may not have been published. In this kind of study, failure to publish research might make self-management programs look better than they really are. WHAT ARE THE IMPLICATIONS OF THE STUDY: Self-management programs may improve blood pressure and glucose control in older patients with high blood pressure and diabetes. Before such programs can be widely recommended, however, we need to learn what types of features make a program most effective. |
| Abstract: | BACKGROUND: Although enthusiasm is growing for self-management programs for chronic conditions, there are conflicting data regarding their effectiveness and no agreement on their essential components. PURPOSE: To assess the effectiveness and essential components of self-management programs for hypertension, osteoarthritis, and diabetes mellitus. DATA SOURCES: The authors searched multiple sources dated through September 2004, including the Cochrane Library, Medline, PsycINFO, and Nursing and Allied Health databases, and bibliographies of 87 previous reviews. STUDY SELECTION: Randomized trials that compared outcomes of self-management interventions with a control or with usual care for diabetes mellitus, osteoarthritis, or hypertension; outcomes included hemoglobin A1c level, fasting blood glucose level, weight, blood pressure, pain, or function. DATA EXTRACTION: Two reviewers independently identified trials and extracted data regarding whether the intervention used tailored adjustments to meet individual patient needs, a group setting, feedback, and psychological services, and whether the intervention was provided by the patient's usual physician. DATA SYNTHESIS: Of 780 studies screened, 53 studies contributed data to the random-effects meta-analysis (26 diabetes studies, 14 osteoarthritis studies, and 13 hypertension studies). Self-management interventions led to a statistically and clinically significant pooled effect size of -0.36 (95% CI -0.52 to -0.21) for hemoglobin A1c, equivalent to a reduction in hemoglobin A1c level of about 0.81%. Self-management interventions decreased systolic blood pressure by 5 mmHg (effect size -0.39, CI -0.51 to -0.28) and decreased diastolic blood pressure by 4.3 mmHg (effect size -0.51, CI -0.73 to -0.30). Pooled effects of self-management interventions were statistically significant but clinically trivial for pain and function outcomes for osteoarthritis. No consistent results supported any of the 5 characteristics examined as essential for program success. LIMITATIONS: Studies had variable quality, and possible publication bias was evident. CONCLUSIONS: Self-management programs for diabetes mellitus and hypertension probably produce clinically important benefits. The elements of the programs most responsible for benefits cannot be determined from existing data, and this inhibits specification of optimally effective or cost-effective programs. Osteoarthritis self-management programs do not appear to have clinically beneficial effects on pain or function. Full text (sometimes free) may be available at these link(s):  help |
