CRD summary

This review assessed the impact of self-care support interventions in UK of people aged 50 years and over with long-term conditions. Most studies reported some significant benefits in physical and psychological function, knowledge and self-efficacy. Methodological weaknesses and limited reporting of some parts of the review process mean the authors' conclusions should be interpreted with caution.

Authors' objectives

To evaluate and assess the impact of self-care support interventions in people with long-term conditions aged 50 years and over.

Searching

CINAHL, EMBASE MEDLINE and PsycINFO were searched for studies published between 1997 and 2008; search terms were reported. The reference lists of Cochrane reviews in this area and five key literature reviews were searched. Handsearches of the journals Patient Education and Counselling, and Chronic Illness were undertaken.

Study selection

Empirical peer-reviewed studies of UK adults with a mean age of 50 years and one or more long-term conditions were eligible for inclusion if the participants received self-care interventions for more than three hours during a period of more than one month. Interventions were delivered by medical professionals or lay people. Outcomes of interest were the processes and outcomes of delivering self-care support. The interventions were required to be delivered in community health or social care settings. An additional inclusion criterion was that commencement of data collection was from 1997 or after.

Studies were excluded where the populations were solely mental health or palliative care service users. Grey literature and non-empirical literature were excluded.

Included interventions were self-care initiatives for patients with arthritis, diabetes and congestive obstructive pulmonary disease (COPD) and stroke. Mean age of participants was 60 years. Patient education was the principal component of all the interventions, which were delivered to small groups through primary or secondary health services and voluntary organisations. Outcome measures examined included physical functioning, self efficacy, quality of life, health service usage, illness knowledge, depression and anxiety. Group programmes were of an average duration of 8.4 hours over several weeks. Typical interventions involved a weekly two-hour group for six weeks. Health professionals delivered the interventions in most studies.

The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection.

Assessment of study quality

Methodological quality was assessed by one reviewer who used a standardised instrument designed for quality assessment of community-based preventive interventions. Study characteristics assessed included description, sampling, measurement, analysis, results interpretation and other execution issues. Scores were assigned to each study and the quality of each study was rated as good (0 to 1), fair (2 to 4) or limited (≥5). Some studies were assessed by a second reviewer.

Data extraction

Data were collected on outcomes that included physical and psychological functioning, illness knowledge, treatment adherence and health service usage. No particular outcomes of interest were determined by the reviewers a priori before data extraction commenced. The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

The results of the included studies were summarised in a narrative review with accompanying tables.

Results of the review

Eighteen studies (n= 3,834) were identified: 14 randomised controlled trials (RCTs); three pre- and post-test studies; and one crossover trial with pre- and post-test design. The sample sizes of the trials ranged between 35 and 629. Follow up ranged between three and 12 months (average eight months). The quality of three trials was rated good; the other 15 studies were rated fair. The mean age of the populations included was 60 years. Attrition rates were higher than 15% in eight studies.

Physical functioning: Six of 12 studies evaluated this outcome and reported statistically significant improvements in physical functioning in studies that enrolled patients with arthritis, diabetes, congestive obstructive pulmonary disease (COPD) and "all conditions". Three studies of patients with arthritis reported improved joint function and protection. Significant improvements were found in exercise undertaken in two of three studies that evaluated this outcome.

One study of five that evaluated pain management reported a modest improvement. Medication adherence was found to be improved in only one study that assessed management of pain.

Illness knowledge: Three of six studies reported increased knowledge by patients about their conditions; two studies of diabetic patients observed that the increase in illness knowledge was associated with subsequent beneficial behaviour change.

Psychological functioning: Three of the six studies of patients with arthritis found significant decreases in depression and anxiety. Seven studies evaluated changes in self-efficacy, which increased after the intervention in five studies. Quality of life scores were observed to be significantly higher in two out of seven studies.

Health service use: Seven studies evaluated service usage and three reported mixed results.

Authors' conclusions

Self-care interventions had some modest beneficial effects in older adults, but further research was required to ascertain how to optimally support self-care in adults over 75 years of age with long-term conditions who may have different requirements than younger patients.

CRD commentary

The review was broad in scope and inclusion and exclusion criteria were defined. Grey literature and data on patients outside UK were excluded, so relevant studies may have been missed and publication bias could not be ruled out. Steps taken to minimise errors and bias were reported only for quality assessment. Little detail on study methods was provided (such as about the controls in the RCTs). Little data was presented in the review on the magnitude of effects observed in the included trials. In particular, insufficient data was provided about losses to follow up, which was reported as more than 15% in nearly half of the included studies. There was a large number of studies that included different components in the intervention, but only a small number of studies reported any outcomes (for example, 16 studies included exercise as a component of an intervention and only three studies reported outcomes for diet and exercise). There was substantial clinical and methodological heterogeneity across the included studies. Most studies were classed only as fair quality. The results of the review were applicable only to older adults in the UK who undertook self-care initiatives in the UK. Limited evidence and potential methodological flaws in the review process made the reliability of the conclusions unclear.

Implications of the review for practice and research

Research: The authors stated that there was a requirement to ascertain the most effective methods of supporting self-care initiatives for older patients (particularly those aged over 75 years) who may have different requirements

Practice: The authors did not state any implications for practice.

Funding

NHS Service Delivery and Organisation Programme.

Bibliographic details

Berzins K, Reilly S, Abell J, Hughes J, Challis D. UK self-care support initiatives for older patients with long-term conditions: a review. Chronic Illness 2009; 5(1): 56-72. [PubMed: 19276226]

Original Paper URL

http://chi.sagepub.com/cgi/content/abstract/5/1/56

Indexing Status

Subject indexing assigned by NLM

MeSH

Aged; Chronic Disease /therapy; Great Britain; Health Policy; Humans; Patient Education as Topic; Self Care

AccessionNumber

12009104979

Database entry date

04/11/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.