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Meta-Analysis
. 2014 Sep 8;2014(9):CD007641.
doi: 10.1002/14651858.CD007641.pub3.

Self-management education for cystic fibrosis

Eileen Savage  1 , Paul V Beirne, Muireann Ni Chroinin, Alistair Duff, Tony Fitzgerald, Dawn Farrell
Affiliations
Meta-Analysis

Self-management education for cystic fibrosis

Eileen Savage et al. Cochrane Database Syst Rev. .

Abstract

Background: Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted.

Objectives: To assess the effects of self-management education interventions on improving health outcomes for patients with cystic fibrosis and their caregivers

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register (date of the last search: 22 August 2013).We also searched databases through EBSCO (CINAHL; Psychological and Behavioural Sciences Collection; PsychInfo; SocINDEX) and Elsevier (Embase) and handsearched relevant journals and conference proceedings (date of the last searches: 01 February 2014 ).

Selection criteria: Randomised controlled trials, quasi-randomised controlled trials or controlled clinical trials comparing different types of self-management education for cystic fibrosis or comparing self-management education with standard care or no intervention.

Data collection and analysis: Two authors assessed trial eligibility and risk of bias. Three authors extracted data.

Main results: Four trials (involving a total of 269 participants) were included. The participants were children with cystic fibrosis and their parents or caregivers in three trials and adults with cystic fibrosis in one trial. The trials compared four different self-management education interventions versus standard treatment: (1) a training programme for managing cystic fibrosis in general; (2) education specific to aerosol and airway clearance treatments; (3) disease-specific nutrition education; and (4) general and disease-specific nutrition education. Training children to manage cystic fibrosis in general had no statistically significant effects on weight after six to eight weeks, mean difference -7.74 lb (i.e. 3.51 kg) (95% confidence interval -35.18 to 19.70). General and disease-specific nutrition education for adults had no statistically significant effects on: pulmonary function (forced expiratory volume at one second), mean difference -5.00 % (95% confidence interval -18.10 to 8.10) at six months and mean difference -5.50 % (95% confidence interval -18.46 to 7.46) at 12 months; or weight, mean difference - 0.70 kg (95% confidence interval -6.58 to 5.18) at six months and mean difference -0.70 kg (95% confidence interval -6.62 to 5.22) at 12 months; or dietary fat intake scores, mean difference 1.60 (85% confidence interval -2.90 to 6.10) at six months and mean difference 0.20 (95% confidence interval -4.08 to 4.48) at 12 months. There is some limited evidence to suggest that self-management education may improve knowledge in patients with cystic fibrosis but not in parents or caregivers. There is also some limited evidence to suggest that self-management education may result in positively changing a small number of behaviours in both patients and caregivers.

Authors' conclusions: The available evidence from this review is of insufficient quantity and quality to draw any firm conclusions about the effects of self-management education for cystic fibrosis. Further trials are needed to investigate the effects of self-management education on a range of clinical and behavioural outcomes in children, adolescents and adults with cystic fibrosis and their caregivers.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias criterion presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias criterion for each included study.
1.1
1.1. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 1 Change in weight (Children).
1.2
1.2. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 2 Number of digestive system self‐management behaviours (Children).
1.3
1.3. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 3 Number of pulmonary system self‐management behaviours (Children).
1.4
1.4. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 4 Frequency of digestive system self‐management behaviours (Children).
1.5
1.5. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 5 Frequency of pulmonary system self‐management behaviours (Children).
1.6
1.6. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 6 Total frequency of digestive and pulmonary self‐management behaviours (Children).
1.7
1.7. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 7 Adherence ‐ percentage of prescribed medications taken by children.
1.8
1.8. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 8 Adherence ‐ percentage of prescribed aerosol treatment taken by children.
1.9
1.9. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 9 Adherence ‐ percentage of prescribed chest physiotherapy treatment taken by children.
1.10
1.10. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 10 Knowledge of cystic fibrosis and its management (Children).
1.11
1.11. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 11 Quality of well‐being (Children).
1.12
1.12. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 12 Number of digestive system self‐management behaviours (Parents).
1.13
1.13. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 13 Number of pulmonary system self‐management behaviours (Parents).
1.14
1.14. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 14 Total number of digestive and pulmonary self‐management behaviours (Parents).
1.15
1.15. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 15 Frequency of digestive system self‐management behaviours (Parents).
1.16
1.16. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 16 Frequency of pulmonary system self‐management behaviours (Parents).
1.17
1.17. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 17 Total frequency of digestive and pulmonary system self‐management behaviours (Parents).
1.18
1.18. Analysis
Comparison 1 Self‐management training versus standard treatment, Outcome 18 Knowledge of cystic fibrosis and its management (Parents).
2.1
2.1. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 1 Adherence ‐ percentage of prescribed aerosol treatment taken by children.
2.2
2.2. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 2 Adherence ‐ percentage of airway clearance treatments taken by children.
2.3
2.3. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 3 Knowledge of aerosol and airway clearance treatments (Children).
2.4
2.4. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 4 Self management assessment behaviours (Caregivers).
2.5
2.5. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 5 Self‐management treatment behaviour (Caregivers).
2.6
2.6. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 6 Self‐management communication behaviour (Caregivers).
2.7
2.7. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 7 Self management responsiveness to airway clearance treatment when child unwell (Caregivers).
2.8
2.8. Analysis
Comparison 2 Self‐management education on aerosol and airway clearance treatments ('Airways') versus standard treatment, Outcome 8 Self efficacy (Caregivers).
3.1
3.1. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 1 Appropriate self‐management of malabsorption (Children).
3.2
3.2. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 2 Inappropriate self‐management of malabsorption (Children).
3.3
3.3. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 3 Knowledge of nutrition and enzymes (Children).
3.4
3.4. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 4 Appropriate self‐management of malabsorption (Caregivers).
3.5
3.5. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 5 Inappropriate self‐management of malabsorption (Caregivers).
3.6
3.6. Analysis
Comparison 3 Disease‐specific nutrition education ('Go and Grow with CF') versus standard treatment, Outcome 6 Knowledge of malabsorption and vitamins (Caregivers).
4.1
4.1. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 1 Per cent predicted FEV1.
4.2
4.2. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 2 Weight.
4.3
4.3. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 3 Dietary fat intake.
4.4
4.4. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 4 Self efficacy.
4.5
4.5. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 5 Knowledge of cystic fibrosis disease‐specific nutrition.
4.6
4.6. Analysis
Comparison 4 General and disease‐specific nutrition education ('Eat Well with CF') versus standard treatment, Outcome 6 Knowledge of general nutrition.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Klijn 2004 {published data only}
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Quittner 2011 {published data only}
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Quittner 2012 {published data only}
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Singer 1991 {published data only}
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Stark 2009 {published data only}
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References to studies awaiting assessment

Bergman 2007 {published data only}
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Cannon 1999 {published data only}
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Jessup 2008 {published data only}
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