Table 4 Summary table of findings of update randomised controlled trials and their relevance to the meta-review questions
From: Systematic meta-review of supported self-management for asthma: a healthcare perspective
Reference and weighting; Participants, n; Risk of bias | Comparison | Relevance to meta-review questions: | Study type and interventions included | Target group(s) | Main results [1o] is the defined primary outcome |
|---|---|---|---|---|---|
What is the impact? Target groups? Which components? Context? | |||||
Al-Sheyab 2012 [48] n = 261 HIGH risk of bias | Adolescent Asthma Action programme vs. standard care. FU: 3 mo | Target: Adolescents Components: Peer education | Cluster RCT. Triple A. Peer leaders from year 11 were trained to deliver programme to years 8, 9 and 10. | Adolescents in Jordanian high school. I group had fewer females, fewer symptoms and higher English proficiency. | Compared to control improvements QoL score improved [I: 5.42 (SD 0.14) vs C: 4.07 (SD 0.14) MD 1.35 (95%CI 1.04–1.76)]. |
Baptist 2013 [49] n = 70 HIGH risk of bias | Personalised asthma self-regulation intervention vs. education session. FU 12 mo | Target: Older adults Components: Health educator | RCT. 6-session programme (group telephone). Patients selected an asthma-specific goal, and addressed potential barriers. Control is single session basic education + 2 telephone calls. | Aged ≥65 y. Physician diagnosis of asthma, no restriction in severity. Majority Caucasian. | No between-group differences in A&E visits or hospitalisations. Healthcare utilisation was lower at 6 mo but not 12 mo. ACQ was similar at 1 mo and 6 mo. At 12 mo, I participants were 4.2 times more likely to have an ACQ score <0.75. [1o] QoL (mAQLQ) was significantly higher in the I than in C at all time points (1, 6 and 12 mo). |
Ducharme 2011 [50] n = 219 LOW risk of bias | ‘Take-home plan’ post A&E visit with PAAP + prescription information vs. prescription but no PAAP/information. FU: 28 days | Target: Children, A&E attendees Components: PAAP with prescription | RCT. Intervention is written PAAP with a ‘formatted’ prescription for ICS (i.e. including information about use) issued by A&E doctor on discharge following asthma exacerbation. | Canadian children 1–17 y recruited during A&E attendance for acute asthma (78% were under the age of 6 y). | No between-group differences in unscheduled care at 28 days. Compared to control, at 28 days children given the PAAP had better asthma control (proportion with Asthma Quiz Score <2 I: 58% vs. C: 41%; RR 1.36, 95% CI 1.04–1.86). No between-group differences in child/caregiver QoL at 28 days. [1o] Adherence to ICS declined from 90% (day 1) to 50% at day 14, with no significant group difference. |
Goeman 2013 [51] n = 114 Low risk of bias | Person-centred education vs. written information. FU: 12 mo | Target: Older adults Components: Personalised education | RCT. Personally tailored education session with asthma educator based on responses to a questionnaire; inhaler technique. | ≥55 y, community-based asthmatics with no restriction in asthma severity. | [1o] At 12 mo I participants had better asthma control than C (ACQ MD 0.3, 95% CI 0.06–0.5, p = 0.01) and better asthma-related QoL (p = 0.01). No significant difference in number of steroid courses (p = 0.17). At 12 mo, more I participants (n = 36, 61%) owned a PAAP compared to C (n = 21, 38%; p = 0.015). [1o] Similar adherence to ICS at 12 mo (p = 0.015). |
Halterman 2014 [52] n = 638 LOW risk of bias | Personalised prompts for clinicians and parents, practice training and feedback vs. written guidelines. FU: 6 mo | Target: Children, deprived communities Components: Feedback Context: Community-based, clinical training | Cluster RCT. Intervention practices received personalised clinician and parent prompts + blank PAAP; practice training; feedback. Control practices sent guidelines. | Urban, primary care practices in deprived communities. Parents/children 2–12 y with persistent, poorly controlled asthma. Recruited from waiting room over 4 ystudy. | 11% in both groups had an A&E visit or hospitalisation. [1o] Compared to control practices, at 2 mo children in the PAIR-UP practices had more symptom-free days [I: 10.2 days/2 weeks (SD 4.8) vs. C: 9.5 days/2 weeks (SD 5.1); MD 0.78, 95% CI 0.29–1.27] but the difference was not significant at 6 mo. Nights with symptoms remained significant at 6 mo [I: 1.4 (SD 3.0) vs. C: 1.8 (SD 3.2); MD −0.43; 95% CI −0.77 to −0.09]. |
Horner 2014 [53] n = 183 UNCLEAR risk of bias | Asthma plan for kids vs. teaching on general health and well-being. FU: 12 mo | Target: Children, rural communities | Cluster RCT. Programme delivered in 16 × 15 min sessions, 3 days/week for 5.5 weeks, by school nurses during lunch break + home visit. | Grades 2–5 (ages 7–11 y) with physician diagnosis of asthma. | No between-group difference for admissions or A&E visits. No between-group difference in QoL scores. Inhaler skill improved in the intervention group compared to control after 4 mo, with reported higher self-efficacy. |
Joseph 2013 [54] n = 422 UNCLEAR risk of bias | Web-based asthma management intervention vs. control. FU: 12 mo | Target: Adolescents, urban deprived, ethnic groups Components: Web-based, behavioural change | RCT. Internet-based programme targeted at African-Americans/urban adolescents with traits (low motivation; low perceived emotional support; resistance to change; rebelliousness). | Grades 9–12 (ages 14–18 y) with physician diagnosis of asthma and report >4 days of restricted activity in the past 30 days at baseline. | No difference in reported A&E visits/hospitalisations at 12 mo. [1o] Compared to C, at 12 mo the I participants had fewer symptom-days (RR 0.8, 95% CI 0.6–1.0). No difference in nights with symptoms, schooldays missed, days of restricted activity or days had to change plans. Students characterised with rebelliousness or low perceived emotional support reported fewer symptom-days. |
Khan 2014 [55] n = 91 HIGH risk of bias | Asthma education + individualised written PAAP vs. asthma education (excluding PAAP). | Target: Ethnic groups Components: Written PAAP | RCT. Both groups received individual asthma education during an OPD visit from a paediatrician + monthly FU. Intervention group trained in using a PAAP. | 1–14 y. Recruited via A&E OPD with partly controlled asthma (daytime or nocturnal symptoms, activity limitation, lung function < 0% best or exacerbation in previous year). | [1o] Trend for improved outcomes at 6 mo but no significant between-group difference in proportion of children attending A&E (I: 36% vs. C: 52%; p = 0.141). There was no between-group difference in unscheduled doctor visits, asthma attacks, missed school days or night-time awakenings. |
Rhee 2011 [56] n = 112 UNCLEAR risk of bias | Peer-led asthma education provided by peers at a day camp vs. adult-led camp. | Target: Adolescents. Components: Peer leaders | RCT. Asthma self-management skills + psychosocial skills taught at a day camp by peer leaders + monthly peer telephone contact. Control: Similar education delivered by adults. No telephone. | 13–17 y (including low-income families). Mild/moderate/severe asthma. Asthma diagnosis for 1 y. Able to understand spoken and written English. | [1o] Both groups reported significantly increased QoL over time (F = 4.31, p = 0.002), with I group having significantly higher QoL at 6 mo (MD 11.38, 95% CI 0.96–21.79, p = 0.03) and 9 mo (MD 12.97, 95% CI 3.46–22.48, p = 0.008). Both groups reported improved attitude to asthma (F = 11.94, p = 0.001), with greater improvement in I at 6 mo (MD 4.11, 95% CI 0.65–7.56, p = 0.02). |
Rikkers-Mutsaerts 2012 [57] n = 90 UNCLEAR risk of bias | Internet-based self –management vs. usual care. FU: 12 mo | Target: Adolescents. Components: Internet-based | RCT. Internet-based self-monitoring with algorithm-based advice. Programme included education (web-based + group), self-monitoring (FEV1 + ACQ), PAAP and 3–6 mo review. | 12–18 y with mild to severe persistent asthma on regular ICS medication and poorly controlled at recruitment. | No between-group differences in exacerbations, physicians’ visits or telephone contacts. [1o] QoL was better in I group at 3 mo (PAQLQ I: 6.00 vs. C: 5.68; MD 0.40, 95% CI 0.17–0.62) but not at 12 mo (I: 5.93 vs. C: 6.05; MD 0.05, 95% CI 0.50–0.41). Asthma control was improved in I group at 3 mo (ACQ I: 0.96 vs. C: 1.19; MD −0.32, 95% CI −0.56 to −0.08) but not at 12 mo (I: 0.83 vs. C: 0.79; MD −0.05, 95% CI −0.35 to 0.25). |
Shah 2011 [58] 150 GPs and 201 children LOW risk of bias | GP training (PACE study) vs. no training. FU: 12 mo | Targets: Children Components: GP training | Cluster RCT. GPs participated in 2 × 3-h workshops on communication and education strategies to facilitate quality asthma care. | 150 GPs and 221 children with asthma in their care. | No between-group difference in hospitalisation/A&E visits (I: 18% vs. C: 12%; difference 6%, 95% CI −4 to 15). No between-group differences in school absence or parent absenteeism for child’s asthma. [1o] More patients in I group GPs had a PAAP (I: 61% vs. C: 46%; difference 15%, 95% CI 2–28). |
van Gaalen 2013 [59] n = 107 HIGH risk of bias | Internet-based self –management vs. control (FU of SMASHING trial). FU: 30 mo | Target: Adults Components: Internet-based | RCT (FU study). Education + PAAP, self-monitoring and regular review. The 200 patients in original 12-mo trial were invited for FU after 18 mo. | Adults with asthma aged 18–50 y, using ICS. 107/200 (54%) participated: I group: 47/101 (47%); C group: 60/99 (61%). Participants ACQ was similar, but AQLQ was greater than in non-participants. | At 30 mo after baseline, there was a slightly attenuated improvement for both QoL (AQLQ adjusted between-group MD 0.29, 95% CI 0.01–0.57) and ACQ (adjusted MD of −0.33, 95% CI −0.61 to −0.05) scores in favour of the intervention. No between-group differences in FEV1. |
Wong 2012 [60] n = 80 HIGH risk of bias | Symptom-based written PAAP vs. verbal counselling. FU: 6 mo | Target: Children, ethnic groups Components: Written PAAP | Single blinded RCT. Intervention was symptom-based PAAP given out at initial contact. Outcomes measured at baseline, 3, 6 and 9 mo. | Malaysian children (mix of Malay, Chinese and Indian) with all severities of asthma. Aged 6–17 y. Recruitment process not described. | At 6 mo there was no difference in A&E visits/unscheduled care [intervention 4 (SD 10.8) vs. control 6 (SD 21.1); p = 0.35]. At 6 mo there was no difference in proportion controlled (ACT ≥ 20 I: 81% vs. C: 87%; p = 0.50), with no exacerbations (ACT ≥ 20 I: 89% vs. C: 82%; p = 0.62) or in QoL [mean PAQLQ I: 6.11 (SD 0.88) vs. 6.11 (SD 1.09); p = 0.99]. |