Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 26, 2020
Open Peer Review Period: Sep 26, 2020 - Nov 21, 2020
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The effect of blended self-management interventions on disease burden in chronic obstructive pulmonary disease and asthma patients: A systematic review and meta-analysis
There is a high prevalence of and high disease burden in Chronic Obstructive Pulmonary Disease (COPD) and asthma. Blended self-management interventions, which combine eHealth with face-to-face interventions, could help to reduce this disease burden.
This systematic review and meta-analysis was performed to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma.
Eligible randomized controlled trials (RCTs) were identified in five databases. Study quality was assessed using the Cochrane Collaboration tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Of the 2694 identified publications, 17 RCTs were included in the systematic review. In the twelve COPD studies mixed effects were observed in the four health-related effectiveness outcomes. A large effect was found on body mass index (d = 0.80) and a small effect on exacerbations (d = 0.25). For (re)admission, no effect was found in the majority of COPD studies, although one study found a moderate effect (d = 0.57). No effect was found on mortality. Eleven process outcomes were studied. One study found a small positive effect on self-management ability (d = 0.26), whereas another study found no effect. No effect was found on the other process outcomes. The five asthma studies included four health-related effectiveness outcomes. The blended self-management intervention had a positive effect on asthma control (d: 0.36 to 2.11), lung function (d: 0.33 to 0.48), and – in the majority of studies - the quality of life (QoL) (d: 0.36 to 0.60), while no effect was found on admission. No effect was reported in all three process outcomes. Seven COPD studies were included in the meta-analysis. A small improvement was found on exercise capacity (g = 0.45, 95% CI: 0.04 to 0.86) and a moderate improvement on QoL (g = 0.54, 95% CI: 0.02 to 1.06). No significant effect was found on dyspnea and lung function. No asthma studies were included in the meta-analysis. Furthermore, the overall risk of bias was relatively low, and the quality of evidence varied.
In COPD patients, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity and QoL. Furthermore, the review suggested that the blended self-management intervention resulted in small to large effects for asthma control, lung function and QoL in asthma patients. The results need to be interpreted carefully, because the quality of evidence varied across studies and because of the limited number of studies. Future RCTs are needed, also to examine the most effective intervention combination and duration. To conclude, there is some evidence the effectiveness of blended self-management interventions for COPD and asthma patients; yet more research is needed to confirm the effectiveness. Clinical Trial: The review was registered in PROSPERO (number 2019: CRD42019119894).
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