Self-management and patient activation in COPD patients: An evidence summary of randomized controlled trials
Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with multiple health problems including physical and psychological impairment as well as socioeconomic deprivation. COPD can be managed if self-management efficiency and disease management knowledge of patients is improved. Patient activation is believed to improve patients' quality of life (QOL) and health outcomes through enhancing self-management skills. This review is an attempt to identify the benefits and knowledge gaps in self-management and patient-activation position in COPD self-management interventions Methods: Four electronic databases (Medline, Pubmed, Google Scholar and Cochrane Airways Group Specialized Register of Trials) were systematically searched from 1 January 2011 to 30 November 2016. The search strategy included the combined use of Medical Subject: Headings (MeSH) term, which are as follows; "Self-management", "Self-care", "Self-treat", "Pulmonary disease", "Chronic Obstructive Pulmonary Disease", "Patient activation", "Patient Activation Measure", "Personalized support", "Chronic Obstructive Pulmonary Disease", "COPD". The screening of the abstracts and full texts of the papers, data extraction and quality assessment were independently done by three reviewers. Results: The results of this review showed that health outcomes (QOL, perceived quality of care, knowledge and severity on disease, lower rate of exacerbation, patient activation level) can be improved by self-management interventions with well cleared content on self-care guidelines and targeted behavior change models that possibly can increase self-efficacy of the patients. However, most of the studies have not applied patient activation which is shown to play a central role in COPD self-management behaviors. Conclusions: This review has identified that there is paucity of literature on patient activation in tailored COPD self-management intervention. As a way forward, there is need to test a well-designed randomized controlled trial considering key points like patients characteristics, compliance, intervention delivery period, multi-morbidity conditions and measurement of the outcomes with standardized tools, might help to arrive at enable scientific conclusions.