Self-management interventions for chronic illness

Newman, Stanton; Steed, Liz; Mulligan, Kathleen

doi:10.1016/s0140-6736(04)17277-2

Cited by 845 publications

(720 citation statements)

References 107 publications

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

“…In six reviews only RCTs were considered [9,10,13,15,18,26,27] (see ESM Table 12). Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified.…”

Section: Resultsmentioning

confidence: 99%

“…Six reviews used regression or subgroup analysis to analyse the effect of single active components on outcomes [9,11,13,15,16,19]. Descriptive analysis of the influence of active components was performed in five reviews [19,21,22,24,26]. Most of the components of our three reference programmes had been identified, but only a few had been evaluated.…”

Section: Resultsmentioning

confidence: 99%

“…setting, duration, interventionist, formal syllabus) [9,11,13,15,16,19,21,22], the type of intervention (e.g. type of disease, type of activity, organisational interventions) [10,18,21,22,[25][26][27] aimed at patients or health professionals, or the study characteristics (e.g. follow-up, age of participants, study quality) [11,13,15,19,24].…”

Section: Resultsmentioning

confidence: 99%

“…Nine reviews included qualitative data synthesis within categories [13,[19][20][21][22][24][25][26][27] (Table 1). In some reviews [10,11,18] the allocation into categories did not meet the type of intervention [32,34,35].…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews.Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed metaanalysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA 1c was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain

Kroenke

Bair

Damush

et al. 2009

JAMA

404

335

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Context Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30% to 50% of the time and have adverse effects on quality of life, disability, and health care costs.Objective To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. Design, Setting, and Patients Randomized controlled trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) conducted at 6 communitybased clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity (Patient Health Questionnaire 9 score Ն10).Intervention Patients were randomly assigned to the intervention (n=123) or to usual care (n=127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program over 12 weeks (step 2), and a continuation phase of therapy for 6 months (step 3).Main Outcome Measures Depression (20-item Hopkins Symptom Checklist), pain severity and interference (Brief Pain Inventory), and global improvement in pain at 12 months.Results At 12 months, 46 of the 123 intervention patients (37.4%) had a 50% or greater reduction in depression severity from baseline compared with 21 of 127 usual care patients (16.5%) (relative risk [RR], 2.3; 95% confidence interval [CI], 1.5-3.2), corresponding to a much lower number of patients with major depression (50 [40.7%] vs 87 [68.5%], respectively; RR, 0.6 [95% CI, 0.4-0.8]). Also, a clinically significant (Ն30%) reduction in pain was much more likely in intervention patients (51 intervention patients [41.5%] vs 22 usual care patients [17.3%]; RR, 2.4 [95% CI, 1.6-3.2]), as was global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7 [95% CI, 2.3-6.1]). More intervention patients also experienced benefits in terms of the primary outcome, which was a combined improvement in both depression and pain (32 intervention patients [26.0%] vs 10 usual care patients [7.9%]; RR, 3.3 [95% CI, 1.8-5.4]). ConclusionOptimized antidepressant therapy followed by a pain selfmanagement program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability.

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Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts

et al. 2015

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Self-management interventions for chronic illness

Cited by 845 publications

References 107 publications

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain

Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts

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