Hanlon Peter, Bryson Iona, Morrison Holly, Rafiq Qasim, Boehmer Kasey, Gionfriddo Michael R, Gallacher Katie, May Carl, Montori Victor, Lewsey Jim, McAllister David A, Mair Frances S
Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA.
Wellcome Open Res. 2021 Oct 11;6:257. doi: 10.12688/wellcomeopenres.17238.1. eCollection 2021.
People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity.
Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions.
PROSPERO CRD42021236980.
2型糖尿病患者需承担一系列任务来管理自身病情，这些任务统称为自我管理。旨在支持自我管理的干预措施在内容和效果上各不相同。本系统评价将利用患者工作量和能力的理论模型，分析2型糖尿病的自我管理干预措施。
检索五个电子数据库（Medline、Embase、CENTRAL、CINAHL和PsycINFO），检索时间从建库至2021年4月27日，并辅以引文检索和参考文献列表的手工检索。两名评审员将独立评审标题、摘要和全文。纳入标准包括：人群：成年2型糖尿病患者；干预措施：自我管理支持干预的随机对照试验；对照：常规护理；结局指标：糖化血红蛋白（主要结局指标）、健康相关生活质量（QOL）、药物依从性、自我效能感、治疗负担、医疗保健利用情况（如就诊次数、住院次数）、2型糖尿病并发症（如肾病、视网膜病变、神经病变、大血管疾病）和死亡率；研究背景：社区。将使用有效实践与护理组织（EPOC）偏倚风险工具评估研究质量。干预措施将根据EPOC分类法和PRISMS自我管理分类法进行分类，并分组为相似的干预措施进行分析。将在亚组内评估临床和方法学异质性，并在适当情况下进行随机效应荟萃分析。否则，将进行叙述性综合分析。干预措施将根据其对患者工作量的可能影响以及对患者能力的支持程度进行分级。将使用元回归探索这些理论结构对研究结局的影响。结论：本综述将在累积复杂性模型理论框架内，对自我管理干预措施进行全面概述。分析将探讨与自我管理相关的工作量以及对患者能力的支持如何影响自我管理干预措施的结局。
PROSPERO CRD42021236980
