Intervention Review

Self-management education programmes by lay leaders for people with chronic conditions

  1. Gill Foster1,*,
  2. Stephanie JC Taylor2,
  3. Sandra Eldridge1,
  4. Jean Ramsay3,
  5. Chris J Griffiths1

Editorial Group: Cochrane Consumers and Communication Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 28 JUL 2006

DOI: 10.1002/14651858.CD005108.pub2


How to Cite

Foster G, Taylor SJC, Eldridge S, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005108. DOI: 10.1002/14651858.CD005108.pub2.

Author Information

  1. 1

    Barts and the London Medical School, Centre for Health Sciences, Institute for Health Science Education, London, UK

  2. 2

    Barts and the London Medical School, Centre for Health Sciences, Institute for Health Science Education , London, UK

  3. 3

    Queen Mary's School of Medicine and Dentistry, University of London, Institute of Health Sciences Education, Centre for Health Sciences, Barts and the London, London, UK

*Gill Foster, Centre for Health Sciences, Institute for Health Science Education, Barts and the London Medical School, 2 Newark Street, London, E1 2AT, UK. g.b.foster@qmul.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Lay-led self-management programmes are becoming widespread in the attempt to promote self-care for people with chronic conditions.

Objectives

To assess systematically the effectiveness of lay-led self-management programmes for people with chronic conditions.

Search methods

We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2005, Issue 1), MEDLINE (January 1986 to May 2006), EMBASE (January 1986 to June 2006), AMED (January 1986 to June 2006), CINAHL (January 1986 to June 2006), DARE (1994 to July 2006, National Research Register (2000 to July 2006), NHS Economic Evaluations Database (1994 to July 2006), PsycINFO (January 1986 to June 2006), Science Citation Index (January 1986 to July 2006), reference lists and forward citation tracking of included studies. We contacted principal investigators and experts in the field. There were no language restrictions.

Selection criteria

Randomised controlled trials (RCTs) comparing structured lay-led self-management education programmes for chronic conditions against no intervention or clinician-led programmes.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Results of RCTs were pooled using a random-effects model with standardised mean differences (SMDs) or weighted mean differences (WMDs) for continuous outcomes.

Main results

We included seventeen trials involving 7442 participants. The interventions shared similar structures and components but studies showed heterogeneity in conditions studied, outcomes collected and effects. There were no studies of children and adolescents, only one study provided data on outcomes beyond six months, and only two studies reported clinical outcomes.

Primary outcomes

Health status: There was a small, statistically-significant reduction in: pain (11 studies, SMD -0.10 (95% confidence interval (CI) -0.17 to -0.04)); disability (8 studies, SMD -0.15 (95% CI -0.25 to -0.05); and fatigue (7 studies, SMD -0.16 (95% CI -0.23 to -0.09); and small, statistically-significant improvement in depression (6 studies, SMD -0.16 95% CI -0.24 to -0.07). There was a small (but not statistically- or clinically-significant) improvement in psychological well-being (5 studies; SMD -0.12 (95% CI -0.33 to 0.09)); but no difference between groups for health-related quality of life (3 studies; WMD -0.03 (95% CI -0.09 to 0.02). Six studies showed a statistically-significant improvement in self-rated general health (WMD -0.20 (95% CI -0.31 to -0.10).

Health behaviours: 7 studies showed a small, statistically-significant increase in self-reported aerobic exercise (SMD -0.20 (95% CI -0.27 to -0.12)) and a moderate increase in cognitive symptom management (4 studies, WMD -0.55 ( 95% CI -0.85 to -0.26)).

Healthcare use: There were no statistically-significant differences between groups in physician or general practitioner attendance (9 studies; SMD -0.03 (95% CI -0.09 to 0.04)). There were also no statistically-significant differences between groups for days/nights spent in hospital (6 studies; WMD -0.32 (95% CI -0.71 to 0.07)).

Self-efficacy: (confidence to manage condition) showed a small statistically-significant improvement (10 studies): SMD -0.30, 95% CI -0.41 to -0.19.

No adverse events were reported in any of the studies.

Authors' conclusions

Lay-led self-management education programmes may lead to small, short-term improvements in participants' self-efficacy, self-rated health, cognitive symptom management, and frequency of aerobic exercise. There is currently no evidence to suggest that such programmes improve psychological health, symptoms or health-related quality of life, or that they significantly alter healthcare use. Future research on such interventions should explore longer term outcomes, their effect on clinical measures of disease and their potential role in children and adolescents.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Self-management education programmes led by lay leaders for people with chronic health conditions

Self-management education programmes led by lay leaders (rather than health professionals such as doctors or nurses) are becoming common as a way of trying to promote self care for people with chronic conditions. We assessed systematically the effects of these programmes. We included results from seventeen studies which involved a total of 7442 people with chronic conditions including arthritis, diabetes, hypertension and chronic pain. While many of the programmes were similar, they differed in which condition they were for, which measurements researchers reported, and how effective the programmes were.

We found that these programmes may lead to modest, short-term improvements in patients' confidence to manage their condition and perceptions of their own health. They also increased how often people took aerobic exercise. Whilst there were small improvements in pain, disability, fatigue and depression, the improvements were not clinically important. The programmes did not improve quality of life, alter the number of times patients visited their doctor or reduce the amount of time spent in hospital. No adverse events were reported in any of the studies.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

由非專業人士所設計之慢性疾病患者自我管理計畫

由非專業人士所設計之自我管理計畫逐漸被廣泛應用於提升慢性疾病患者的自我管理能力。

目標

系統性評估由非專業人士所設計慢性疾病患者自我管理計畫之效果。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2005, 第1期) 、以及MEDLINE (1986年1月至2006年5月) 、EMBASE (1986年1月至2006年6月) 、AMED (1986年1月至2006年6月) 、CINAHL (1986年1月至2006年6月) 、DARE (1994年至2006年7月) 、National Research Register (2000年至2006年7月) 、NHS Economic Evaluations Database (1994年至2006年7月) 、PsycINFO (1986年1月至2006年6月) 、Science Citation Index (1986年1月至2006年7月) 等資料庫、參考文獻目錄以及曾引用我們所納入文獻的研究,我們還聯繫了計畫主持人與這個領域的專家學者。我們的搜尋並無語言上之限制。

選擇標準

隨機對照試驗 (Randomised controlled trials, RCTs) 的主題是比較由非專業人士所設計之慢性疾病患者自我管理計畫跟無介入、或由醫師主導的計畫之間的差異。

資料收集與分析

由2位作者獨立評估所納入研究之品質以及摘錄資料。我們還聯繫了原作者以取得額外資訊。所有RCTs的結果皆運用隨機效應模式 (randomeffects model) 加以統整,連續變項則以標準均差 (standardised mean differences, SMDs) 或加權均差 (weighted mean differences, WMDs) 的方式呈現。

主要結論

我們共納入了17個試驗,總共包括有7442位參與者。雖然這些研究所採取的介入在結構和組成上相類似,但在研究的疾病種類、研究結果的收集與效果之評估上則則不盡相同。在這之中,並無以兒童及青少年為對象之研究,僅有1個研究有提供6個月以上的數據;且只有2個研究報告了臨床預後。在健康狀況的主要研究結果上:雖然差異不大,統計上已達顯著降低的指標有:疼痛(11個研究,標準均差為 −0.10,SMD −0.10 (95% confidence interval (CI) −0.17 to −0.04)) ;失能(8個研究,SMD −0.15 (95% CI −0.25 to −0.05) 以及疲勞SMD −0.16 (95% CI −0.23 to −0.09) 。雖然差異不大,但統計上已達顯著改善的指標為:憂鬱(6個研究,SMD −0.16 95% CI −0.24 to −0.07) 。可觀察到些微改善,但統計或臨床上未達顯著差異的指標為:心理的安適狀態(5個研究 −0.12 (95% CI −0.33 to 0.09) 。然而,有些指標則並未在兩組間呈現差異,包括健康相關的生活品質(3個研究,WMD −0.03 (95% CI −0.09 to 0.02) 。6個研究顯示自評整體健康狀況在統計上有顯著改善, (WMD −0.20 (95% CI −0.31 to −0.10) 。在健康行為方面,有7個研究顯示,自我報告有氧運動之次數上在兩組間差異雖小,但在統計上有顯著的增加 (SMD −0.20 (95% CI −0.27 to −0.12) ;在認知症狀的管理上則有適度之進步 (4個研究,WMD −0.55 (95% CI −0.85 to −0.26) 。在醫療資源利用上,兩組間在專科醫師或家庭醫師的就醫次數上無統計顯著的差異 (9個研究,SMD −0.03 (95% CI −0.09 to 0.04)) ,且需住院的情形在兩組間亦並無統計上顯著的差異 (6個研究,WMD −0.32 (95% CI −0.71 to 0.07)) 。在自我效能方面(即管理自身情況之自信),兩組間的差異雖小,但已在統計上有顯著的改善 (10個研究,SMD −0.30, 95% CI −0.41 to −0.19) 。在所有研究中,並無任何不良反應事件被報告。

作者結論

由非專業人士所設計之慢性疾病患者自我管理計畫對於參與者的自我效能、自評健康狀況、認知症狀管理、以及有氧運動頻率上,可有些微且短暫的改善;但目前沒有證據顯示這項計畫可改善患者的心理健康、臨床症狀、健康相關生活品質,或是可明顯改變其醫療資源的利用情形。未來應更進一步探討此計畫的長期研究結果、對於臨床疾病之影響、以及在兒童及青少年所扮演之潛在角色。

翻譯人

本摘要由成功大學附設醫院邱曉萱翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

由非專業人士所設計之慢性疾病患者自我管理計畫由非專業人士,而非由醫師或護士等醫療專業人員設計之教育計畫已逐漸成為ㄧ種提升慢性疾病病患自我管理之方式。我們系統性評估了這類型計畫的功效。我們共納入了17項試驗,總參與者人數為7442位病患,研究的疾病種類包括關節炎、糖尿病、高血壓及慢性疼痛等。即使大多數研究的介入內容是相似的,但在研究的疾病種類、研究結果之呈現方式、與計畫之有效性方面則仍有所不同。我們發現這類型計畫可適度且短暫改善病患對於自我管理的自信,以及自我健康狀況之認知;同時會增加病患有氧運動之次數。雖然對於疼痛、失能、疲勞及憂鬱可有些微改善,但在臨床上並無顯著意義。這項計畫並未改善生活品質、亦無法減少就醫次數或降低住院時間。在所有研究中,並無任何不良反應事件被報告。