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Self‐management programmes for cirrhosis: A systematic review
Author(s) -
Boudreault Samuel,
Chen Junqiao,
Wu Kevin Y.,
Plüddemann Annette,
Heneghan Carl
Publication year - 2020
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.15416
Subject(s) - medicine , cinahl , psycinfo , cirrhosis , medline , quality of life (healthcare) , meta analysis , systematic review , randomized controlled trial , self management , incidence (geometry) , physical therapy , family medicine , intensive care medicine , psychological intervention , nursing , physics , optics , machine learning , political science , computer science , law
Background and aims Liver cirrhosis severely decreases patients' quality of life. Since self‐management programmes have improved quality of life and reduce hospital admissions in other chronic diseases, they have been suggested to decrease liver cirrhosis burden. Methods We performed a systematic review and meta‐analysis to evaluate the clinical impact of self‐management programmes in patients with liver cirrhosis, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Primary outcomes include health‐related quality of life (HRQOL) and hospitalisation. We searched MEDLINE, CENTRAL, Embase, CINAHL, PsycINFO and two trial registers to July 2017. Results We identified four randomised trials (299 patients) all rated at a high risk of bias. No difference was demonstrated for HRQOL (standardised mean difference −0.01, 95% CI: −0.48 to 0.46) and hospitalisation days (incidence rate ratio 1.6, 95% CI: 0.5–4.8). For secondary outcomes, one study found a statistically significant improvement in patient knowledge (mean difference (MD) 3.68, 95% CI: 2.11–5.25) while another study found an increase in model for end‐stage liver disease scores (MD 2.8, 95% CI: 0.6–4.9) in the self‐management group. No statistical difference was found for the other secondary outcomes (self‐efficacy, psychological health outcomes, healthcare utilisation, mortality). Overall, the quality of the evidence was low. The content of self‐management programmes varied across studies with little overlap. Conclusions The current literature indicates that there is no evidence of a benefit of self‐management programmes for people with cirrhosis. Relevance to clinical practice Practitioners should use self‐management programmes with caution when delivering care to patients living with cirrhosis. Further research is required to determine what are the key features in a complex intervention like self‐management. This review offers a preliminary framework for clinicians to develop a new self‐management programme with key features of effective self‐management interventions from established models.