Self management of patients with mild COPD in primary care: randomised controlled trial

Objective: To evaluate the effectiveness of nurse-led telephone health coaching to encourage self-management in a primary care population with mild symptoms of COPD. Design: Pragmatic, multi-centre randomised controlled trial. Setting: 71 general practices in four areas of England. Participants: 577 people, with MRC dyspnoea grade 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis, were randomised to the intervention (n=289) or usual care (n=288). Interventions: Nurse-delivered telephone health coaching intervention, underpinned by Social Cognitive Theory, promoting: accessing smoking cessation services, increasing physical activity, medication management and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). Nurses received two days of training. The usual care group received a leaflet about COPD. Main outcome measures: The primary outcome was health related quality of life at 12 months using the short version of the St Georges Respiratory Questionnaire (SGRQ-C). Results: The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of participants received all four calls. 92% participants were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95%CI -3.6 to 0.9; p=0.2). Compared to usual care participants, at six months follow-up, the intervention group reported significantly greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%) and inhaler technique check (68% v 55%). There were no differences in other secondary outcomes (dyspnoea, smoking cessation, anxiety, depression, self-efficacy, objectively measured physical activity). Conclusions A novel telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self-management activities, but did not improve health related quality of life. Trial registration Current controlled trials ISRCTN 0671039

Data file

The checklist responses for each trial alongside an indication of whether a problem with the description of the intervention was reported prior to publicatio

‘”There’s words”: Dylan Thomas et la langue.’

Table S1. List of medicinal products withdrawn because of adverse drug reactions. (PDF 2375 kb

Moving Focus from Weight to Health. What Are the Components Used in Interventions to Improve Cardiovascular Health in Children?

<div><p>Introduction</p><p>Obesity in childhood impacts on many areas of the child’s current and future health, including their cardiovascular health. To date many attempts have been made to design interventions to tackle excess childhood weight but with limited success. We aimed to establish the components common to interventions in children that improve cardiovascular health parameters.</p><p>Methods</p><p>We searched the following databases: EMBASE 1974-week 3 November 2014, Ovid Medline 1946 Present, and PsychINFO 1967-Present for studies reporting interventions in healthy young people under the age of 18. Included interventions had to contain an education component and have been carried out in a community, school, or clinical setting. Papers had to report on at least one of the pre-specified CVD risk parameters and at least one non-biological outcome from knowledge, attitudes or behaviours.</p><p>Results</p><p>We retrieved 2451 papers, from which 12 studies (18 papers) of 3046 participants were included. From the selected papers we identified four component themes; Health Behaviours, Self-Concept, Practical and Cognitive Tools, and Intervention Characteristics. The subcomponents that made up these themes were fairly consistent across the studies analysed although the studies varied in their duration, settings and children with which they were carried out. Nine of the studies were able to bring about positive change in at least one biological and one non-biological aspect of child cardiovascular health.</p><p>Conclusion</p><p>The component themes identified here were common to intervention studies that had success in improving parameters of cardiovascular health. We suggest that the focus of childhood health interventions be moved from weight onto cardiovascular health parameters and that future interventions use the lessons learned by their predecessors to incorporate those components that are associated with successful interventions.</p></div

Selection process of papers included in the component analysis.

<p>Selection process of papers included in the component analysis.</p

Characteristics of included studies.

<p>Characteristics of included studies.</p

Component themes.

<p>Component themes.</p

HEJ-17-0175_supplementary_material – Supplemental material for Characteristics and efficacy of digital health education: An overview of systematic reviews

<p>Supplemental material, HEJ-17-0175_supplementary_material for Characteristics and efficacy of digital health education: An overview of systematic reviews by Marcy McCall, Elizabeth Spencer, Helen Owen, Nia Roberts and Carl Heneghan in Health Education Journal</p

Forest plot showing the effect of blinding of outcome assessment on effect size.

<p>Forest plot showing the effect of blinding of outcome assessment on effect size.</p

AMSTAR Criteria for included studies^*.

<p>*1 = yes, 2 = no, 3 = can't answer, 4 =  not applicable.</p