Review on Blended Self-management Shows Mixed Results on Relieving COPD Burden

A systematic meta-analysis found mixed results on the effectiveness for blended self-management interventions in patients with chronic obstructive pulmonary disease (COPD) or asthma, suggesting that more research is needed to confirm potential benefits.

“In this systematic review, limited studies have investigated the effects of blended interventions in patients with asthma. Therefore, the findings should be interpreted cautiously, and future studies with larger sample sizes are needed,” wrote the investigators.

The review, published in the Journal of Medical Internet Research, highlighted the lack of evidence needed to establish whether blended self-management processes, which combines aspects of face-to-face self-management and telehealth self-management, is effective at improving health outcomes, exercise capacity, quality of life, and admission rates.

Face-to-face self-management interventions are helpful at equipping patients with tools and skills needed to manage their conditions successfully but can be difficult to access due to distance and time constraints. eHealth methods can be a time and cost saver and offer patients flexibility but programs are difficult to personalize to individuals and raise data security concerns.

Blended interventions have the potential to bring the benefits and mitigate the negative aspects of both self-management methods. Current reviews suggest that blended interventions could help patients. However, the reviews tend not to focus on chronic lung diseases, process outcomes, or self-management interventions specifically.

The investigators searched 5 databases on December 28, 2018 and November 30, 2020 for randomized controlled trials (RCTs) on blended self-management in COPD and asthma. For studies to be eligible, they had to include participants aged 18 years or older who have COPD or asthma, featured comparisons between blended self-management and face-to-face interventions or usual health care, and examine health-related effectiveness or process outcomes.

Out of 4495 eligible trials detected, 15 COPD and 7 asthma studies were included in the analysis. The average age of patients with COPD and patients with asthma ranged from 64.10 to 73.50 years and 24.80 and 52.00 years, respectively. The duration of blended self-management lasted for an average of 22.13 [16.20] weeks for patients with COPD and 15.88 [13.48] weeks for patients with asthma.

In the meta-analysis, COPD studies showed that blended interventions yielded a small improvement in exercise capacity (standardized mean difference [SMD], 0.48; 95% CI, 0.10-0.85). There was also a significant improvement in quality of life (SMD, 0.81; 95% CI, 0.11-1.51) and reduced hospital admission rates (RR, 0.61; 95% CI, 0.38-0.97).

The systematic review of 2 COPD studies revealed that blended interventions reduced exacerbation frequency (RR, 0.38; 95% CI, 0.26-0.56). A large effect on body mass index (BMI) was observed in an analysis including only 1 study, making the effect inconclusive.

Of the 3 studies that addressed medication adherence, 2 found a moderate effect (d = 0.73; 95% CI, 0.50-0.96) and the other reported a mixed effect. Also, 1 study reported a large effect on the ability to self-manage COPD (d = 1.15; 95% CI, 0.66-1.62). No effect on process outcomes was found.

Among the asthma studies, the meta-analysis found that blended intervention had a small improvement on lung function (SMD, 0.40; 95% CI, 0.18-0.62) and quality of life (SMD, 0.36; 95% CI, 0.21-0.50). Asthma control was found to have moderately improved (SMD, 0.67; 95% CI, 0.35-2.50) as well.

A large effect was observed on BMI (d = 1.42; 95% CI, 0.28-2.42) and exercise capacity (d = 1.50; 95% CI, 0.35-2.50). However only 1 study was examined per outcome.

Quality of the trial results varied, with 10 out of the 15 COPD studies and 4 out of the 7 asthma studies being rated as having “some concerns” regarding risk of bias. Additionally, 5 of the COPD studies and 3 of the asthma studies were rated as having a “high risk” of bias.

The review and meta-analysis had several limitations, including that there may have been some statistical heterogeneity in the true effect size, only a small number of studies reported the same outcome measure, and studies with small sample sizes were included. Additionally, evidence quality varied, there was an inability to assess the risk of publication bias, and not all studies reported a follow-up.

“Larger RCTs are required to provide more insights, especially RCTs examining the effects of blended interventions in patients with asthma. Moreover, data reporting should be performed in an exact, standardized format to enable reliable extraction for future meta-analysis studies,” the investigators suggested.

Reference

Song X, Hallensleben C, Zhang W, et al. Blended self-management interventions to reduce disease burden in patients with chronic obstructive pulmonary disease and asthma: Systematic review and meta-analysis. J Med Internet Res. Published online March 31, 2021. doi: 10.2196/24602