Characteristics of nursing interventions that improve the quality of life of people with chronic diseases. A systematic review with meta-analysis

Abstract

Purpose The objective of this systematic review was to determine the characteristics of the interventions conducted by nurses that attempt to improve the health related quality of life (HRQoL) of people over 18 years of age with chronic diseases. Methods This systematic review with meta-analysis summarizes 24 studies, conducted in 10 countries, that evaluated HRQoL through the Short-Form Health Survey (SF). Five databases were accessed to find the available studies from December 31 st , 2000 to May 22 sd , 2017. Selected studies were coded according to the characteristics of the sample and the intervention. A model of random effects was adopted for the overall estimation and to explain the heterogeneity. Results Twenty-four studies were included in the systematic review and meta-analysis providing a sample of 4324 chronic patients aged 63.4 years. Among the 8 subscales and two summary measures that comprise the SF-36, only an overall significant effect size (ES) index was found in the Mental Health Component summary score (ES = 0.14; 95% CI:0.03 − 0.26; I 2 = 44.6, p = 0.042) and the Mental Health subscale. This improvement on HRQoL was associated to interventions on “Case Management” and “Treatments and Procedures”, which were based on a theory, were of shorter duration, and had a follow-up period. Conclusions Interventions targeting people with chronic diseases resulted in a slight increase in the HRQoL that was not always significant, which suggests that there is a need for their continuous improvement.

What works in managing complex conditions in older people in primary and community care? A state‐of‐the‐art review

“…The effect of length of intervention was influenced by outcome type in LTCs. Shorter interventions led to better mental functioning scores (Amo‐Setien et al., 2019); longer interventions improved HbA1c levels but not blood pressure (Berntsen et al., 2019). Longer case management interventions in dementia were associated with reduced institutionalisation (Pimouguet et al., 2010), but not for other care models compared to usual care (Godard‐Sebillotte et al., 2019).…”

“…In one review, having a theoretical basis was associated with improved mental functioning in nursing interventions for LTCs compared to controls (details not reported; effect size = 0.331, 95% CI 0.186–0.476, n = 13), although only 21% included studies reported being based on a theory (Amo‐Setien et al., 2019). A range of theories were reported in primary studies, such as self‐management models, the theory of vulnerability and Bandura's self‐efficacy theory (Chow & Wong, 2014; Markle‐Reid et al, 2006).…”

“…Models of care including assessment with information provision or active management (actions taken by specific designated health professionals as opposed to recommendations or referrals) reduced nursing home admissions of frail older people compared to usual care, but had no impact upon functioning or service use (Beswick, Gooberman‐Hill, Smith, Wylde, & Ebrahim, 2010). Including active procedures (technical activities related to symptom prevention or alleviation such as wound care, specimen collection, resistive exercises or prescribing medication) was associated with greater effects upon mental functioning in nurse‐led models of care for LTCs compared to teaching, guiding and counselling (Amo‐Setien et al., 2019). One trial in one review found involving frail patients in care planning had more positive outcomes (Eklund & Wilhelmson, 2009).…”

“…However, intervention characteristics including education had no effect upon use of acute hospital services for people with dementia compared to usual care (Godard‐Sebillotte et al., 2019). Teaching patients in nurse‐led interventions did not impact upon mental functioning (which includes vitality, social and emotional functioning and mental health) in LTCs (Amo‐Setien et al., 2019).…”

“…While a theoretical basis was highlighted as an effective component (Amo‐Setien et al., 2019), Amo‐Setien et al's included studies reported a wide range of theories and there no evidence to support the use of one particular theory over another. Self‐management approaches and focussing on patient priorities in disease management were also highlighted as key aspects of care coordination interventions in a realist review (Kastner et al., 2019), but these are sometimes paid less attention in models of care (Briggs et al., 2018).…”