IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
Hull York Medical School, University of York, John Hughlings Jackson Building, Heslington, York, Y010 5DD, UK.
NPJ Prim Care Respir Med. 2019 Nov 29;29(1):41. doi: 10.1038/s41533-019-0152-8.
Chronic breathlessness is debilitating and frightening, often resulting in emergency department presentations with acute-on-chronic breathlessness. Self-management is complex, involving 14 components as identified by the Practical Systematic Review in Self-Management Support (PRISMS). Low-intensity educational interventions that support breathlessness self-management through written/visual educational materials, alongside limited health professional support, are available. Our aim was to describe components of low-intensity educational interventions that support and improve self-management for adults with chronic breathlessness and evaluate their efficacy for improving breathlessness-related outcomes. A systematic review was conducted, including RCTs that compared these interventions with usual care in adults with chronic disease. Synthesis took a narrative approach utilizing the PRISMS taxonomy and Template for Intervention Description and Replication (TIDieR) checklist. Of the 1948 articles identified, 7 met criteria reporting 7 RCTs using 6 interventions. Studies utilized 12 out of 14 PRISMS components, the most frequent being training/rehearsal for psychological strategies. Evidence for effectiveness was inconsistent and attempts to identify beneficial components were confounded by intervention complexity and heterogeneity. The optimal content and delivery of low-intensity educational interventions that support self-management to improve chronic breathlessness-related outcomes in adults cannot be defined from current published literature. Future research should incorporate more detailed, standardized reporting to enable comparison and meta-analysis.
慢性呼吸困难使人虚弱和恐惧，经常导致慢性呼吸困难急性加重的急诊科就诊。自我管理很复杂，涉及到实用系统综述在自我管理支持（PRISMS）中确定的 14 个组成部分。有一些低强度的教育干预措施，通过书面/视觉教育材料来支持呼吸困难的自我管理，并辅以有限的卫生专业人员支持。我们的目的是描述支持和改善慢性呼吸困难成年人自我管理的低强度教育干预措施的组成部分，并评估它们对改善呼吸困难相关结果的效果。进行了系统评价，包括比较这些干预措施与慢性疾病成年人常规护理的 RCT。综合采用 PRISMS 分类法和干预描述与复制模板（TIDieR）清单进行叙述性方法。在确定的 1948 篇文章中，有 7 篇符合标准，报告了 7 项 RCT，使用了 6 种干预措施。研究利用了 14 个 PRISMS 组成部分中的 12 个，最常见的是心理策略的培训/排练。有效性的证据不一致，并且试图确定有益的组成部分受到干预复杂性和异质性的混淆。从目前发表的文献中无法确定支持自我管理以改善成年人慢性呼吸困难相关结局的低强度教育干预措施的最佳内容和交付方式。未来的研究应采用更详细、标准化的报告，以实现比较和荟萃分析。
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