Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Prev Chronic Dis. 2013;10:120112. doi: 10.5888/pcd10.120112.
The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program's effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline.
We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes.
Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months
Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.
慢性病自我管理计划（CDSMP）是一种基于社区的自我管理教育计划，旨在帮助参与者获得信心（自我效能感）和技能，以更好地管理他们的慢性疾病；它已经在世界范围内实施。本荟萃分析的目的是定量综合在英语国家进行的 CDSMP 研究结果，以确定该计划在基线后 4 至 6 个月和 9 至 12 个月时对健康行为、身心健康状况和医疗保健利用的影响。
我们搜索了 8 个电子数据库，以确定从 1999 年 1 月 1 日至 2009 年 9 月 30 日发表的与 CDSMP 相关的文献；专家确定了其他未发表的研究。我们合并了所有合格研究的结果来计算汇总效应大小。我们纳入了 23 项研究。其中 18 项研究报道了小型英语群体的数据；我们对这些研究进行了 1 项荟萃分析，并对其他交付模式的结果进行了单独分析。
在小型英语群体的健康行为方面，有氧运动、认知症状管理和与医生的沟通在 4 至 6 个月的随访中显著改善；有氧运动和认知症状管理在 9 至 12 个月时仍显著改善。拉伸/增强运动在 9 至 12 个月时显著改善。所有心理健康指标在 4 至 6 个月和 9 至 12 个月时均显著改善。能量、疲劳和自我评定健康在 4 至 6 个月时有较小但显著的改善，但在 9 至 12 个月时没有。医疗保健利用的唯一显著变化是在 4 至 6 个月时住院天数或住院夜数略有减少。
在 12 个月后，心理健康和一些健康行为的小到中度改善表明，在小型英语群体中提供的 CDSMP 为参与者带来了健康益处，并且将成为综合慢性病管理策略的重要组成部分。
