Kuo Chia-Chi, Lin Chiu-Chu, Tsai Fu-Mian
Advanced Practice Nurse, Emergency Department, Chi-Mei Medical Center, and doctoral candidate, School of Nursing, Kaohsiung Medical University, and Assistant Professor, Department of Nursing, Chang Jung Christian University, Tainan, Taiwan.
Worldviews Evid Based Nurs. 2014 Oct;11(5):301-15. doi: 10.1111/wvn.12066.
Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects.
To evaluate the effects of EBSMIs on patients with chronic metabolic diseases.
A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2.
Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients' hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales.
EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.
慢性代谢疾病的管理近来已成为一个重要的全球健康问题。针对慢性代谢疾病患者的基于赋权的自我管理干预措施（EBSMI）已开展了广泛研究，但尚无系统评价对其效果进行评估。
评估基于赋权的自我管理干预措施对慢性代谢疾病患者的效果。
进行了一项系统评价和荟萃分析。检索了五个电子数据库（华艺数位图书馆、护理学与健康照护领域数据库、考克兰图书馆、医学期刊数据库和台湾期刊文献索引系统），检索时间从各数据库最早收录年份至2012年10月。纳入了关于干预措施对慢性代谢疾病患者有效性的对照试验。每项研究由三名评价者进行评估，并根据改良的雅达量表确定证据等级。提取的数据使用Review Manager 5.2软件录入并分析。
共审查了19项研究。大多数研究表明，基于赋权的自我管理干预措施改善了患者的糖化血红蛋白检测（HbA1c）（p <.00001）、腰围（p =.02）和赋权水平（p =.004）。四项研究比较了对体重和体重指数的影响，但总体效果不显著（分别为p =.33和.73）。五项研究比较了对自我效能的影响，其中四项表明有显著提高。然而，由于研究使用的量表不同，未对自我效能的总体效果进行比较。
基于赋权的自我管理干预措施改善了慢性代谢疾病患者的糖化血红蛋白检测结果、腰围、自我效能和赋权水平。在实施基于赋权的自我管理干预措施时，医疗机构需要提供与赋权相关的培训项目，卫生专业人员可从中获得患者赋权方面的能力。此外，医疗机构领导者应评估并克服在临床环境中实施基于赋权的自我管理干预措施的障碍（如时间、人力、成本等）。
