P39 Self-management interventions for people with chronic obstructive pulmonary disease (COPD). Do they work? A systematic review and meta-analysis

Introduction A key role in caring for people with long term respiratory conditions such as COPD, is to support and empower them to manage their own condition. However, the evidence to support self-management in COPD is not clear. Aims/Objectives This systematic review aimed to review and summarise the current evidence base surrounding the effectiveness of self-management interventions (SMIs) for improving health related quality of life (HRQOL) in people with COPD. Methods Systematic reviews that focused upon SMIs were eligible for inclusion. Intervention descriptions were coded for behaviour change techniques (BCTs) that targeted self-management behaviours to address 1) physical symptoms, 2) physical activity, and 3) mental health. Meta-analyses and meta-regression were used to explore the association between health behaviours targeted by SMIs, the BCTs used, patient illness severity, and modes of delivery, with the impact on HRQOL and emergency department (ED) visits. Findings/Results Data related to SMI content were extracted from 26 randomised controlled trials identified from 11 systematic reviews. Patients receiving SMIs reported improved HRQOL (standardised mean difference =-0.16; 95% confidence interval [CI] =-0.25, -0.07; P=0.001) and made fewer ED visits (standardised mean difference =-0.13; 95% CI =-0.23, -0.03; P=0.02) compared to patients who received usual care. Patients receiving SMIs targeting mental health alongside physical symptom management had greater improvement of HRQOL (Q=4.37; P=0.04) and fewer ED visits (Q=5.95; P=0.02) than patients receiving SMIs focused on symptom management alone. Within-group analyses showed that HRQOL was significantly improved in 1) studies with COPD patients with severe symptoms, 2) single-practitioner based SMIs but not SMIs delivered by a multidisciplinary team, 3) SMIs with multiple sessions but not single session SMIs, and 4) both individual- and group-based SMIs. Summary/Conclusion/Recommendations for Practice SMIs can be effective at improving HRQOL and reducing ED visits, with those targeting mental health being significantly more effective than those targeting symptom management alone. Self-management plans should include managing physical symptoms, physical activity, and mental health. Respiratory nurses are ideally placed to do this.