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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].
  1. Abbreviations: A&E accident and emergency, ACQ Asthma Control Questionnaire, ACT Asthma Control Test, AQLQ Asthma-related Quality of Life Questionnaire, C control, CI confidence interval, FEV 1 forced expiratory volume in one second, FU follow-up, GP general practitioner, I intervention, ICS inhaled corticosteroid, mAQLQ mini Asthma-related Quality of Life Questionnaire, MD mean difference, mo months, PAAP personalised asthma action plan, PAQLQ paediatric asthma-related quality of life, QoL quality of life, RCT randomised controlled trial, RR risk ratio, SD standard deviation, y years