Dataset Information

Self-management interventions for adults with chronic kidney disease: a scoping review.

ABSTRACT:

Objective

To systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD).

Setting

Community-based.

Participants

Adults with CKD stages 1-5 (not requiring kidney replacement therapy).

Interventions

Self-management strategies for adults with CKD.

Primary and secondary outcome measures

Using a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-management interventions for adults with CKD stages 1-5 (not requiring kidney replacement therapy). Randomised controlled trials (RCTs), non-RCTs, qualitative and mixed method studies were included and study selection and data extraction were independently performed by two reviewers. Outcomes included behaviours, cognitions, physiological measures, symptoms, health status and healthcare.

Results

Fifty studies (19 RCTs, 7 quasi-experimental, 5 observational, 13 pre-post intervention, 1 mixed method and 5 qualitative) reporting 45 interventions were included. The most common intervention topic was diet/nutrition and interventions were regularly delivered face to face. Interventions were administered by a variety of providers, with nursing professionals the most common health professional group. Cognitions (ie, changes in general CKD knowledge, perceived self-management and motivation) were the most frequently reported outcome domain that showed improvement. Less than 1% of the interventions were co-developed with patients and 20% were based on a theory or framework.

Conclusions

There was a wide range of self-management interventions with considerable variability in outcomes for adults with CKD. Major gaps in the literature include lack of patient engagement in the design of the interventions, with the majority of interventions not applying a behavioural change theory to inform their development. This work highlights the need to involve patients to co-developed and evaluate a self-management intervention based on sound theories and clinical evidence.

SUBMITTER: Donald M

PROVIDER: S-EPMC5875600 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Self-management interventions for adults with chronic kidney disease: a scoping review.

Donald Maoliosa M Kahlon Bhavneet Kaur BK Beanlands Heather H Straus Sharon S Ronksley Paul P Herrington Gwen G Tong Allison A Grill Allan A Waldvogel Blair B Large Chantel A CA Large Claire L CL Harwood Lori L Novak Marta M James Matthew T MT Elliott Meghan M Fernandez Nicolas N Brimble Scott S Samuel Susan S Hemmelgarn Brenda R BR

BMJ open 20180322 3

<h4>Objective</h4>To systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD).<h4>Setting</h4>Community-based.<h4>Participants</h4>Adults with CKD stages 1-5 (not requiring kidney replacement therapy).<h4>Interventions</h4>Self-management strategies for adults with CKD.<h4>Primary and secondary outcome measures</h4>Using a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-manageme ...[more]

PMID: 29567848

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Project description:BackgroundSelf-management intervention aims to facilitate an individual's ability to make lifestyle changes. The effectiveness of this intervention in non-dialysis patients with chronic kidney disease (CKD) is limited. In this study, we applied a systematic review and meta-analysis to investigate whether self-management intervention improves renoprotection for non-dialysis chronic kidney disease.MethodsWe conducted a comprehensive search for randomized controlled trials addressing our objective. We searched for studies up to May 12, 2018. Two reviewers independently evaluated study quality and extracted characteristics and outcomes among patients with CKD within the intervention phase for each trial. Meta-regression and subgroup analyses were conducted to explore heterogeneity.ResultsWe identified 19 studies with a total of 2540 CKD patients and a mean follow-up of 13.44?months. Compared with usual care, self-management intervention did not show a significant difference for risk of all-cause mortality (5 studies, 1662 participants; RR 1.13; 95% CI 0.68 to 1.86; I2 =?0%), risk of dialysis (5 studies, 1565 participants; RR 1.35; 95% CI 0.84 to 2.19; I2 =?0%), or change in eGFR (8 studies, 1315 participants; SMD -0.01; 95% CI -0.23 to 0.21; I2 =?64%). Moreover, self-management interventions were associated with a lower 24?h urinary protein excretion (4 studies, 905 participants; MD -?0.12?g/24?h; 95% CI -0.21 to -?0.02; I2 =?3%), a lower blood pressure level (SBP: 7 studies, 1201 participants; MD -?5.68?mmHg; 95%CI -?9.68 to -?1.67; I2 =?60%; DBP: 7 studies, 1201 participants; MD -?2.64?mmHg, 95% CI -3.78 to -?1.50; I2 =?0%), a lower C-reactive Protein (CRP) level (3 studies, 123 participants; SMD -2.8; 95% CI -2.90 to -?2.70; I2 =?0%) and a longer distance on the 6-min walk (3 studies, 277 participants; SMD 0.70; 95% CI 0.45 to 0.94; I2 =?0%) when compared with the control group.ConclusionsWe observed that self-management intervention was beneficial for urine protein decline, blood pressure level, exercise capacity and CRP level, compared with the standard treatment, during a follow-up of 13.44?months in patients with CKD non-dialysis. However, it did not provide additional benefits for renal outcomes and all-cause mortality.

Project description:BACKGROUND:Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients' self-management skills. OBJECTIVE:This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS:Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS:Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients' adherence to interventions. CONCLUSIONS:eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.

Project description:BackgroundThere is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, "self-management support" is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted.ObjectiveThe objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management.MethodsA scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis.ResultsA total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong.ConclusionsOn the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale.

Project description:BackgroundSelf-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated.ObjectiveThe objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease.MethodsWe conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the sample).ResultsWe identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome.ConclusionsThis scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context.

Project description:BACKGROUND:Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes. METHODS:Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death. RESULTS:Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p?<?0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference -?4.26 mmHg, 95% CI -?7.81 to -?0.70, p?=?0.02) and glycated hemoglobin (mean difference -?0.5%, 95% CI -?0.8 to -?0.1, p?=?0.01) compared to usual care. CONCLUSIONS:Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42015017316 .

Project description:BackgroundPrimary care providers manage the majority of patients with chronic kidney disease (CKD), although the most effective chronic disease management (CDM) strategies for these patients are unknown. We assessed the efficacy of CDM interventions used by primary care providers managing patients with CKD.MethodsThe Medline, Embase and Cochrane Central databases were systematically searched (inception to November 2014) for randomized controlled trials (RCTs) assessing education-based and computer-assisted CDM interventions targeting primary care providers managing patients with CKD in the community. The efficacy of CDM interventions was assessed using quality indicators [use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), proteinuria measurement and achievement of blood pressure (BP) targets] and clinical outcomes (change in BP and glomerular filtration rate). Two independent reviewers evaluated studies for inclusion, quality and extracted data. Random effects models were used to estimate pooled odds ratios (ORs) and weighted mean differences for outcomes of interest.ResultsFive studies (188 clinics; 494 physicians; 42 852 patients with CKD) were included. Two studies compared computer-assisted intervention strategies with usual care, two studies compared education-based intervention strategies with computer-assisted intervention strategies and one study compared both these intervention strategies with usual care. Compared with usual care, computer-assisted CDM interventions did not increase the likelihood of ACEI/ARB use among patients with CKD {pooled OR 1.00 [95% confidence interval (CI) 0.83-1.21]; I2 = 0.0%}. Similarly, education-related CDM interventions did not increase the likelihood of ACEI/ARB use compared with computer-assisted CDM interventions [pooled OR 1.12 (95% CI 0.77-1.64); I2 = 0.0%]. Inconsistencies in reporting methods limited further pooling of data.ConclusionsTo date, there have been very few randomized trials testing CDM interventions targeting primary care providers with the goal of improving care of people with CKD. Those conducted to date have shown minimal impact, suggesting that other strategies, or multifaceted interventions, may be required to enhance care for patients with CKD in the community.

Project description:Background:Multidisciplinary chronic kidney disease (CKD) clinics improve patient outcomes but their optimal design is unclear. Objective:To perform a scoping review to identify and describe current practices (structure, function) associated with multidisciplinary CKD clinics. Design:Scoping review. Setting:Databases included Medline, EMBASE, Cochrane, and CINAHL. Patients:Patients followed in multidisciplinary CKD clinics globally. Measurements:Multidisciplinary CKD clinic composition, entry criteria, follow-up, and outcomes. Methods:We systematically searched the literature to identify randomized controlled trials, non-randomized interventional studies, or observational studies of multidisciplinary CKD clinics defined by an outpatient setting where two or more allied health members (with or without a nephrologist) provided longitudinal care to 50 or more adult or pediatric patients with CKD. Included studies were from 2002 to present. Searches were completed on August 10, 2018. Title, abstracts, and full texts were screened independently by two reviewers with disagreements resolved by a third. We abstracted data from included studies to summarize multidisciplinary CKD clinic team composition, entry criteria, follow-up, and processes. Results:40 studies (8 randomized controlled trials and 32 non-randomized interventional studies or observational studies) involving 23?230 individuals receiving multidisciplinary CKD care in 12 countries were included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis patients, one conservative therapy) while two studies focused on adolescents or children with CKD. The multidisciplinary team included a mean of 4.6 (SD 1.5) members consisting of a nephrologist, nurse, dietician, social worker, and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies respectively. Entry criteria to multidisciplinary CKD clinics ranged from glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD stages 1 to 5 without any proteinuria or risk equation-based criteria. Frequency of follow-up was variable by severity of kidney disease. Team member roles and standardized operating procedures were infrequently reported. Limitations:Unstandardized definition of multidisciplinary CKD care, studies limited to CKD defined by glomerular filtration rate, and lack of representation from countries other than Canada, Taiwan, the United States, and the United Kingdom. Conclusions:There is heterogeneity in multidisciplinary CKD team composition, entry criteria, follow-up, and processes with inadequate reporting of this complex intervention. Additional research is needed to determine the best model for multidisciplinary CKD clinics. Trial registration:Not applicable.

Dataset Information

Self-management interventions for adults with chronic kidney disease: a scoping review.

Objective

Setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusions

Publications

Self-management interventions for adults with chronic kidney disease: a scoping review.

Similar Datasets

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