viernes, 25 de septiembre de 2015

automanejo y epoc. Self-management effective for chronic obstructive pulmonary disease

Self-management effective for chronic obstructive pulmonary disease

November 04, 2014
written by Brian R McAvoy

Clinical question
Do self-management interventions in chronic obstructive pulmonary disease (COPD) lead to improved health outcomes and/or reduced healthcare utilisation?

Bottom line
Self-management interventions in patients with COPD were associated with improved health-related quality of life as measured by the St George’s Respiratory Questionnaire, a reduction in respiratory-related hospital admissions and improvement in dyspnoea as measured by the modified Medical Research Council Scale. Over 1 year of follow-up, the NNT* to prevent respiratory-related hospital admissions ranged from 8 (high baseline risk) to 20 (low baseline risk). No statistically significant differences were found in other outcome parameters (all-cause hospitalisation, mortality, exercise capacity).
*NNT = number needed to treat to benefit 1 individual

Caveat
It was not possible to pool head-to-head trials because of heterogeneity among interventions, study populations, follow-up time and outcome measures. Hospital-based and rehabilitation centre–based rehabilitation programmes were excluded because self-management often is only a minor part of these very intensive programmes.

Context
Self-management interventions help patients with COPD acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease.

Cochrane Systematic Review
Zwerink M et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Reviews, 2014, Issue 3. Art. No.: CD002990.DOI: 10.1002/14651858. CD002990.pub3. This review contains 29 studies involving 3688 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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