Objective

To characterize and explain variation in the comparative effectiveness of self-care interventions on relevant outcomes of chronic illness compared with controls.

Design

Meta-analysis and meta-regression.

Methods

Data extraction was framed within the context of a previously-published scoping review of randomized trials designed to enhance self-care in type 2 diabetes mellitus, heart failure, hypertension, asthma, coronary artery disease, and chronic obstructive pulmonary disease (published between 2008 and 2019). Data were pooled using random-effects meta-analyses. Meta-regression was used to test the effect of potential moderators on trial effectiveness.

Results

145 trials involving 36,853 participants were included. Overall, the effect size of self-care interventions on improving outcomes was small (Hedges' g = 0.29 (95% CI = 0.25–0.33), p < 0.001) with statistically significant heterogeneity across trials (Q = 514.85, p < 0.001, I² = 72.0%). A majority of trials (n = 83, 57.2%) were rated as having a high risk of bias. There was no statistically significant difference in trial effectiveness based on the use of theory, specific components of self-care addressed, the number of modes of delivery, the number of behavioral change techniques, specific modes of delivery, specific behavioral change techniques, intervention duration, total number of hours of intervention, or either participant age or gender.

Conclusions

Self-care interventions are modestly effective in improving outcomes. Poor trial quality limits the strength of conclusions in this area of science. There is much to be done to enhance the design, conduct and reporting of self-care trials in order to gain more insight into the effectiveness of self-care interventions.

中文翻译：

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慢性病自我保健干预的有效性：随机对照试验的荟萃分析

客观的

与对照组相比，描述和解释自我保健干预对慢性病相关结果的比较有效性的变化。

设计

元分析和元回归。

方法

数据提取是在先前发表的旨在加强 2 型糖尿病、心力衰竭、高血压、哮喘、冠状动脉疾病和慢性阻塞性肺病的自我保健的随机试验的范围审查的背景下进行的（发表于 2008 年至2019）。使用随机效应荟萃分析汇总数据。元回归用于测试潜在调节因素对试验有效性的影响。

结果

纳入了 145 项试验，涉及 36,853 名参与者。总体而言，自我保健干预对改善结果的影响很小（Hedges' g  = 0.29（95% CI = 0.25-0.33），p < 0.001），试验间的异质性具有统计学意义（Q  = 514.85，p < 0.001，I ²  = 72.0%)。大多数试验（n = 83, 57.2%）被评为具有高偏倚风险。基于理论的使用、自我保健的特定组成部分、分娩方式的数量、行为改变技术的数量、特定的分娩方式、特定的行为改变技术、干预持续时间，试验有效性没有统计学上的显着差异，干预总小时数，或参与者年龄或性别。

结论

自我保健干预在改善结果方面是适度有效的。试验质量差限制了该科学领域结论的强度。为了更深入地了解自我保健干预措施的有效性，还有很多工作需要加强自我保健试验的设计、实施和报告。