Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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A substantial proportion of chronic disease patients do not respond to self-management interventions, which suggests that one size interventions do not fit all, demanding more tailored interventions. To compose more individualized strategies, we aim to increase our understanding of characteristics associated with patient activation for self-management and to evaluate whether these are disease-transcending. A cross-sectional survey study was conducted in primary and secondary care in patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and Chronic Renal Disease (CRD). Using multiple linear regression analysis, we analyzed associations between self-management activation (13-item Patient Activation Measure; PAM-13) and a wide range of socio-demographic, clinical, and psychosocial determinants. Furthermore, we assessed whether the associations between the determinants and the PAM were disease-transcending by testing whether disease was an effect modifier. In addition, we identified determinants associated with low activation for self-management using logistic regression analysis. We included 1154 patients (53% response rate); 422 DM-II patients, 290 COPD patients, 223 HF patients and 219 CRD patients. Mean age was 69.6±10.9. Multiple linear regression analysis revealed 9 explanatory determinants of activation for selfmanagement: age, BMI, educational level, financial distress, physical health status, depression, illness perception, social support and underlying disease, explaining a variance of 16.3%. All associations, except for social support, were disease transcending. This study explored factors associated with varying levels of activation for self-management. These results are a first step in supporting clinicians and researchers to identify subpopulations of chronic disease patients less likely to be engaged in self-management. Increased scientific efforts are needed to explain the greater part of the factors that contribute to the complex nature of patient activation for self-management.
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The primary aims of this study were (1) to evaluate whole-body mechanical efficiency (ME) in a large group of chronic obstructive pulmonary disease (COPD) patients with a wide range of degrees of illness and (2) to examine how ME in COPD is related to absolute work rate and indices of disease severity during exercise testing. A total of 569 patients (301 male patients; GOLD stage I: 28, GOLD stage II: 166, GOLD stage III: 265, and GOLD stage IV: 110) with chronic obstructive pulmonary disease (COPD) were included in the data analysis. Individual maximal workload (watt), peak minute ventilation ((Equation is included in full-text article.)E, L/min body temperature and pressure, saturated), and peak oxygen uptake ((Equation is included in full-text article.)O2, mL/min standard temperature and pressure, dry) were determined from a maximal incremental cycle ergometer test. Ventilatory and metabolic response parameters were collected during a constant work rate test at 75% of the individual maximal workload. From the exercise responses of the constant work rate test, the gross ME was calculated. The mean whole-body gross ME was 11.0 ± 3.5% at 75% peak power. The ME declined significantly (P < .001) with increasing severity of the disease when measured at the same relative power. Log-transformed absolute work rate (r = .87, P < .001) was the strongest independent predictor of gross ME. Body mass was the single other variable that contributed significantly to the linear regression model. Gross ME in COPD was largely predicted by the absolute work rate (r = .87; P < .001) while indices of the severity of the disease did not predict ME in COPD.
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AANLEIDING Mensen met Chronic Obstructive Pulmonary Disease (COPD) hebben vaak langdurig fysiotherapie nodig. Symptomen zoals kortademigheid en vermoeidheid, veelal in combinatie met beperkte gezondheidsvaardigheden (46%), beïnvloeden hun leven sterk. Persoonsgerichte zorg is afgestemd op iemands persoonlijke behoeften, wensen en voorkeuren. Dit vereist dat fysiotherapeuten zinvol gebruik maken van meetresultaten. Zinvol betekent meetresultaten integreren in het zorgproces, deze communiceren op een begrijpelijke manier voor de patiënt, om samen te beslissen en zodoende tot persoonsgerichte zorg te komen. Echter, fysiotherapeuten vinden het lastig om meetresultaten zinvol te gebruiken in het zorgproces en de ervaren meerwaarde van gebruik van meetresultaten is beperkt. In de dagelijkse praktijk ontbreekt het fysiotherapeuten aan praktische handvatten om meetresultaten zinvoller te gebruiken ten behoeve van verdere personalisatie van fysiotherapeutische zorg. DOEL Het bevorderen van inzicht, kennis, vaardigheden en attitude van fysiotherapeuten in het zinvol gebruiken van meetresultaten voor patiënten met COPD. Dit willen we bereiken door: • Praktische handvatten voor zinvol gebruik van meetresultaten, wat leidt tot een transparanter, efficiënter en effectiever zorgproces. • Een verschuiving naar meer persoonsgerichte zorg, waarbij patiënten actief betrokken worden bij hun zorgproces en ongelijkheid in zorg wordt verminderd. CONSORTIUM Zuyd Hogeschool, Hogeschool Utrecht, Amsterdam UMC, LUMC, Nivel, Chronisch ZorgNet, KNGF, Longfonds, Mens Achter de Patiënt, 7 eerstelijns fysiotherapiepraktijken. ONDERZOEKSPLAN De doelstellingen worden gerealiseerd met een mixed methods design met vier, onderling samenhangende, werkpakketten (WP) met elk een specifieke focus. WP1: Verdiepend inzicht (maand 1-12) WP2: Handvatten selecteren en (door)ontwikkelen met de praktijk (maand 1-13) WP3: Handvatten testen met de praktijk (maand 13-20) WP4: Disseminatie (maand 13-24) RELEVANTIE Dit project is relevant omdat eerstelijns fysiotherapeuten beter toegerust worden om meetresultaten zinvol te kunnen gebruiken voor persoonsgerichte zorg bij patiënten met COPD. In het verlengde daarvan dragen ze bij aan het verminderen van ongelijkheid in zorg, betere gezondheidsuitkomsten en meer patiënttevredenheid.
