Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China.
J Med Internet Res. 2021 Mar 31;23(3):e24602. doi: 10.2196/24602.
Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden.
This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma.
PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation.
A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied.
In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed.
PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894.
慢性阻塞性肺疾病（COPD）和哮喘的患病率和疾病负担很高。混合自我管理干预措施，将电子健康与面对面干预相结合，可以帮助减轻疾病负担。
本系统评价和荟萃分析旨在研究混合自我管理干预措施对 COPD 或哮喘患者健康相关效果和过程结果的有效性。
2018 年 12 月在 PubMed、Web of Science、Cochrane 图书馆、Emcare 和 Embase 进行了检索，并于 2020 年 11 月进行了更新。使用 Cochrane 偏倚风险（ROB）2 工具和推荐评估、制定和评估（GRADE）对研究质量进行评估。
共有 15 项 COPD 和 7 项哮喘随机对照试验纳入本研究。COPD 研究的荟萃分析发现，混合干预在运动能力方面有较小的改善（标准化均数差 [SMD] 0.48；95%置信区间 [CI] 0.10-0.85），生活质量（QoL）有显著改善（SMD 0.81；95%CI 0.11-1.51）。混合干预还降低了入院率（相对比值 [RR] 0.61；95%CI 0.38-0.97）。在 COPD 系统评价中，关于加重频率，两项研究均发现干预降低了加重频率（RR 0.38；95%CI 0.26-0.56）。发现 BMI 有较大的影响（d=0.81；95%CI 0.25-1.34）；然而，由于只有 1 项研究被纳入，因此效果不确定。关于药物依从性，3 项研究中有 2 项发现中度效果（d=0.73；95%CI 0.50-0.96），1 项研究报告了混合效果。关于自我管理能力，1 项研究报告了较大的效果（d=1.15；95%CI 0.66-1.62），而该研究没有报告效果。其他过程结果没有效果。哮喘研究的荟萃分析发现，混合干预对肺功能（SMD 0.40；95%CI 0.18-0.62）和 QoL（SMD 0.36；95%CI 0.21-0.50）有较小的改善，对哮喘控制有中度改善（SMD 0.67；95%CI 0.40-0.93）。发现 BMI 有较大的影响（d=1.42；95%CI 0.28-2.42）和运动能力（d=1.50；95%CI 0.35-2.50）；然而，每个结果仅纳入了 1 项研究。其他结果没有效果。此外，22 项研究中的大多数都对 ROB 存在一些担忧，证据质量也存在差异。
在 COPD 患者中，混合自我管理干预措施对健康相关结果有混合效果，在运动能力、QoL 和入院率方面有最强的证据。此外，该综述表明，干预对哮喘患者的肺功能和 QoL 有较小的影响，对哮喘控制有中度的影响。有一些证据表明混合自我管理干预措施对 COPD 和哮喘患者有效；然而，还需要更多的研究。
PROSPERO 国际前瞻性系统评价注册中心 CRD42019119894；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894。
