Beruflich Dokumente
Kultur Dokumente
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2008, Issue 4
http://www.thecochranelibrary.com
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ACKNOWLEDGEMENTS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.1. Comparison 1 Self-management vs. Usual Care, Outcome 1 Lung Function. . . . . . . . . . .
Analysis 1.2. Comparison 1 Self-management vs. Usual Care, Outcome 2 Exacerbations (% Patients). . . . . .
Analysis 1.3. Comparison 1 Self-management vs. Usual Care, Outcome 3 Exacerbations (Mean). . . . . . . .
Analysis 1.4. Comparison 1 Self-management vs. Usual Care, Outcome 4 School Absences (% Patients). . . . . .
Analysis 1.5. Comparison 1 Self-management vs. Usual Care, Outcome 5 School Absences (mean days). . . . . .
Analysis 1.6. Comparison 1 Self-management vs. Usual Care, Outcome 6 Restricted Activity (% Patients). . . . .
Analysis 1.7. Comparison 1 Self-management vs. Usual Care, Outcome 7 Restricted Activity (Mean Days). . . . .
Analysis 1.8. Comparison 1 Self-management vs. Usual Care, Outcome 8 Nights Nocturnal Asthma (% Patients). .
Analysis 1.9. Comparison 1 Self-management vs. Usual Care, Outcome 9 Nights Nocturnal Asthma. . . . . . .
Analysis 1.10. Comparison 1 Self-management vs. Usual Care, Outcome 10 Self-efficacy Scale. . . . . . . . .
Analysis 1.11. Comparison 1 Self-management vs. Usual Care, Outcome 11 Asthma Severity Score. . . . . . .
Analysis 1.12. Comparison 1 Self-management vs. Usual Care, Outcome 12 General Practitioner Visits. . . . . .
Analysis 1.13. Comparison 1 Self-management vs. Usual Care, Outcome 13 ED Visits (% Patients). . . . . . .
Analysis 1.14. Comparison 1 Self-management vs. Usual Care, Outcome 14 ED Visits (mean). . . . . . . . .
Analysis 1.15. Comparison 1 Self-management vs. Usual Care, Outcome 15 Hospitalization (% patients). . . . .
Analysis 1.16. Comparison 1 Self-management vs. Usual Care, Outcome 16 Hospitalizations (mean). . . . . . .
Analysis 2.1. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 1 Lung Function.
Analysis 2.2. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 2 Exacerbation (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.3. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 3 Exacerbations
(Mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.4. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 4 School Absences (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.5. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 5 School Absences
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.6. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 6 Restricted Activity
(% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.7. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 7 Restricted Activity
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.8. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 8 Nights Nocturnal
Asthma (% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.9. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 9 Nights Nocturnal
Asthma (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.10. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 10 Self-Efficacy
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.11. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 11 Asthma Severity
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1
1
2
2
3
3
5
9
10
10
11
14
50
61
62
62
63
63
64
65
65
66
66
67
67
68
69
70
71
72
72
73
73
74
75
76
77
77
78
79
i
Analysis 2.12. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 12 General Practitioner
visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.13. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 13 ED Visit (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.14. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 14 ED Visits
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.15. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 15 Hospitalization (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 2.16. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.1. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 1 Lung Function.
Analysis 3.2. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 2 Exacerbation (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.3. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 3 Exacerbations
(Mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.4. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 4 School Absences
(% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.5. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 5 School Absences
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.6. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 6 Restricted Activity
(% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.7. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 7 Restricted Activity
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.8. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 8 Nights Nocturnal
Asthma (% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.9. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 9 Nights Nocturnal
Asthma (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.10. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 10 Self-Efficacy
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.11. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 11 Asthma Severity
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.12. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 12 General
Practitioner visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.13. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 13 ED Visit (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.14. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 14 ED Visits
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.15. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 15 Hospitalization
(% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 3.16. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.1. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 1 Lung Function. . .
Analysis 4.2. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 2 Exacerbation (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.3. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 3 Exacerbations (Mean).
Analysis 4.4. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 4 School Absences (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.5. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 5 School Absences (mean
days).
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.6. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 6 Restricted Activity (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.7. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 7 Restricted Activity (mean
days).
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
80
81
82
83
84
85
86
87
87
88
89
90
91
91
92
93
94
95
96
97
98
99
100
101
102
102
103
104
ii
Analysis 4.8. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 8 Nights Nocturnal Asthma
(% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.9. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 9 Nights Nocturnal Asthma
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.10. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 10 Self-Efficacy Scale.
Analysis 4.11. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 11 Asthma Severity
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.12. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 12 General Practitioner
visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.13. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 13 ED Visit (% patients).
Analysis 4.14. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 14 ED Visits (mean).
Analysis 4.15. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 15 Hospitalization (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 4.16. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.1. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 1 Lung Function. .
Analysis 5.2. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 2 Exacerbation (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.3. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 3 Exacerbations
(Mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.4. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 4 School Absences (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.5. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 5 School Absences (mean
days).
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.6. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 6 Restricted Activity (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.7. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 7 Restricted Activity
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.8. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 8 Nights Nocturnal
Asthma (% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.9. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 9 Nights Nocturnal
Asthma (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.10. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 10 Self-Efficacy
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.11. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 11 Asthma Severity
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.12. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 12 General Practitioner
visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.13. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 13 ED Visit (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.14. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 14 ED Visits (mean).
Analysis 5.15. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 15 Hospitalization (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 5.16. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 6.1. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 1 Lung Function. . . . . .
Analysis 6.2. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 2 Exacerbation (% patients). .
Analysis 6.3. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 3 Exacerbations (Mean). . .
Analysis 6.4. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 4 School Absences (% patients).
Analysis 6.5. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 5 School Absences (mean days).
Analysis 6.6. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 6 Restricted Activity (% patients).
Analysis 6.7. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 7 Restricted Activity (mean days).
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
105
105
106
107
108
109
110
111
112
113
113
114
115
115
116
117
118
118
119
119
120
121
122
123
124
125
126
127
127
128
129
130
iii
Analysis 6.8. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 8 Nights Nocturnal Asthma (%
Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 6.9. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 9 Nights Nocturnal Asthma
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 6.10. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 10 Self-Efficacy Scale. . . .
Analysis 6.11. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 11 Asthma Severity Scale. .
Analysis 6.12. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 12 General Practitioner visits
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 6.13. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 13 ED Visit (% patients). .
Analysis 6.14. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 14 ED Visits (mean). . . .
Analysis 6.15. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 15 Hospitalization (% patients).
Analysis 6.16. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 16 Hospitalizations (mean). .
Analysis 7.1. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 1 Lung
Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.2. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 2
Exacerbation (% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.3. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 3
Exacerbations (Mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.4. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 4 School
Absences (% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.5. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 5 School
Absences (mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.6. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 6
Restricted Activity (% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.7. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 7
Restricted Activity (mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.8. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 8 Nights
Nocturnal Asthma (% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.9. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 9 Nights
Nocturnal Asthma (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.10. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 10 SelfEfficacy Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.11. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 11
Asthma Severity Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.12. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 12
General Practitioner visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.13. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 13 ED
Visit (% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.14. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 14 ED
Visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.15. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 15
Hospitalization (% patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 7.16. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment, Outcome 16
Hospitalizations (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.1. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 1 Lung Function.
Analysis 8.2. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 2 Exacerbation (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.3. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 3 Exacerbations
(Mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.4. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 4 School Absences (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.5. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 5 School Absences
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
131
131
132
133
134
135
136
137
138
139
140
141
142
142
143
144
145
145
146
147
148
149
150
151
152
153
154
155
155
156
iv
Analysis 8.6. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 6 Restricted Activity (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.7. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 7 Restricted Activity
(mean days). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.8. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 8 Nights Nocturnal
Asthma (% Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.9. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 9 Nights Nocturnal
Asthma (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.10. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 10 Self-Efficacy
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.11. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 11 Asthma Severity
Scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.12. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 12 General Practitioner
visits (mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.13. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 13 ED Visit (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.14. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 14 ED Visits
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.15. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 15 Hospitalization (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 8.16. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.1. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 1 Lung Function. . . .
Analysis 9.2. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 2 Exacerbation (% patients).
Analysis 9.3. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 3 Exacerbations (Mean).
Analysis 9.4. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 4 School Absences (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.5. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 5 School Absences (mean
days).
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.6. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 6 Restricted Activity (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.7. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 7 Restricted Activity (mean
days).
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.8. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 8 Nights Nocturnal Asthma (%
Patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.9. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 9 Nights Nocturnal Asthma
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.10. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 10 Self-Efficacy Scale. .
Analysis 9.11. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 11 Asthma Severity Scale.
Analysis 9.12. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 12 General Practitioner visits
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.13. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 13 ED Visit (% patients).
Analysis 9.14. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 14 ED Visits (mean). .
Analysis 9.15. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 15 Hospitalization (%
patients). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 9.16. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 16 Hospitalizations
(mean). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
WHATS NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INDEX TERMS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
157
157
158
159
159
160
161
162
163
164
165
166
167
168
169
169
170
171
172
172
173
174
175
176
177
178
179
179
179
180
180
180
180
v
[Intervention Review]
of Medical Education & Biomedical Informatics, University of Washington School of Medicine, Seattle, WA, USA.
of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 3 University of Michigan, Ann
Arbor, MI 48109-0368, USA. 4 School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA. 5 Community
Health Sciences, St Georges, University of London, London, UK
2 Department
Contact address: Fredric Wolf, Department of Medical Education & Biomedical Informatics, University of Washington School of
Medicine, E-312 Health Sciences, Box 357240, Seattle, WA, 98195-7240, USA. wolf@u.washington.edu.
Editorial group: Cochrane Airways Group.
Publication status and date: Edited (no change to conclusions), published in Issue 4, 2008.
Review content assessed as up-to-date: 31 July 2002.
Citation: Wolf F, Guevara JP, Grum CM, Clark NM, Cates CJ. Educational interventions for asthma in children. Cochrane Database
of Systematic Reviews 2002, Issue 4. Art. No.: CD000326. DOI: 10.1002/14651858.CD000326.
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Self-management education programs have been developed for children with asthma, but it is unclear whether such programs improve
outcomes.
Objectives
To determine the efficacy of asthma self-management education on health outcomes in children.
Search strategy
Systematic search of the Cochrane Airways Groups Special Register of Controlled Trials and PSYCHLIT, and hand searches of the
reference lists of relevant review articles.
Selection criteria
Randomized and controlled clinical trials of asthma self-management education programs in children and adolescents aged 2 to 18
years.
Data collection and analysis
All studies were assessed independently by two reviewers. Disagreements were settled by consensus. Study authors were contacted for
missing data or to verify methods. Subgroup analyses examined the impact of type and intensity of educational intervention, selfmanagement strategy, trial type, asthma severity, adequacy of follow-up, and study quality.
Main results
Of 45 trials identified, 32 studies involving 3706 patients were eligible. Asthma education programs were associated with moderate
improvement in measures of airflow (standardized mean difference [SMD] 0.50, 95% confidence interval [CI] 0.25 to 0.75) and selfefficacy scales (SMD 0.36, 95% CI 0.15 to 0.57). Education programs were associated with modest reductions in days of school absence
(SMD -0.14, 95% CI -0.23 to -0.04), days of restricted activity (SMD -0.29, 95% CI -0.49 to -0.08), and emergency room visits
(SMD -0.21, 95% CI -0.33 to -0.09). There was a reduction in nights disturbed by asthma when pooled using a fixed-effects but
not a random-effects model. Effects of education were greater for most outcomes in moderate-severe, compared with mild-moderate
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
asthma, and among studies employing peak flow versus symptom-based strategies. Effects were evident within the first six months, but
for measures of morbidity and health care utilization, were more evident by 12 months.
Authors conclusions
Asthma self-management education programs in children improve a wide range of measures of outcome. Self-management education
directed to prevention and management of attacks should be incorporated into routine asthma care. Conclusions about the relative
effectiveness of the various components are limited by the lack of direct comparisons. Future trials of asthma education programs should
focus on morbidity and functional status outcomes, including quality of life, and involve direct comparisons of the various components
of interventions.
BACKGROUND
Asthma is the most prevalent chronic pulmonary disorder afflicting children (Shamssain 1999; Habbick 1999; McFadden 1992).
The prevalence of diagnosed asthma has been growing over the
past 20 years (Magnus 1997; Senthilselvan 1998). Of greater concern is that both asthma morbidity and mortality appear to be
increasing (Ng 1999). This increase is seen particularly in lower
socioeconomic groups and in minority populations (Cunningham
1996). Children with asthma suffer a high number of school absences (Doull 1996), endure a high and increasing rate of disability (Perrin 1999; Newacheck 2000), and incur substantial health
care costs (Lozano 1997).
Self-management educational programs for children with asthma
have been developed in recent years in recognition of the need to
improve health care practices, reduce morbidity, and lower costs of
care (Hurd 1992; Clark 1989). To be successful, programs must be
based on a sound theoretical understanding of behavior change and
employ self-management strategies designed to improve knowledge, skills, and feelings of self-control (Clark 1994). A number
of educational programs have been the subject of rigorous evaluations (Lewis 1984; Wilson-Pessano 1985; Clark 1986a; Clark
1986b; Evans 1987; Creer 1976; Hindi-Alexander 1984; Parcel
1980). These programs incorporate a variety of educational strategies, are designed for different clinical settings, and are targeted to
different patient groups.
While it has become increasingly clear that limited asthma education involving only information transfer is ineffective (Gibson
1999), the effectiveness of self-management education programs
in children with asthma is unclear. In adults with asthma, the use
of a self-management education program that includes self-monitoring, regular medical review, and an asthma action plan does
appear to improve measures of morbidity and reduce health care
utilization (Gibson 1998). In children, however, a published metaanalysis of 11 self-management teaching programs concluded that
asthma self-management programs do not reduce morbidity or
decrease health care utilization (Bernard-Bonnin 1995). This research synthesis was limited to trials published prior to 1992, and a
large number of studies have been published subsequently. Therefore, a new review that incorporates more recent studies may help
to clarify the uncertainty regarding the effectiveness of asthma education in children.
The purpose of this study was to systematically review the research
literature on the efficacy of self-management educational inter-
OBJECTIVES
The specific study objectives were two-fold:
(1) To determine the effectiveness of self-management education
programs on measures of physiological function, morbidity and
functional status, self-perception, and health care utilization in
children and adolescents with asthma.
(2) To determine the characteristics of self-management education programs and trials that are associated with improvements in
health outcomes in children and adolescents with asthma.
METHODS
Types of studies
Randomized controlled trials (RCTs) and controlled clinical trials
(CCTs) were considered in this systematic review.
Types of participants
Studies of children and adolescents with asthma from two to 18
years of age were included.
Types of interventions
Any educational intervention targeted to children or adolescents
(and/or their parents) designed to teach one or more self-management strategies related to prevention, attack management, or social
skills using any instructional strategy or combination of strategies
(problem solving, role-playing, videotapes, computer assisted instruction, booklets, etc.) presented either individually or in group
sessions was included in the review.
Types of outcome measures
Categories of outcomes examined for this review are based on a
consensus of clinically relevant outcomes from the Asthma Outcomes Conference and adapted from Clark and Starr-Schneidkrauts model of patient management (Clark 1994). These outcome categories are (1) physiological function, (2) morbidity and
Electronic searches
We identified studies from the Cochrane Airways Groups trials register comprised of references from MEDLINE, EMBASE,
CINAHL, and hand searched airways-related journals. This
database was searched using the following terms:
asthma OR wheez* AND education* OR self management OR
self-management.
The Airways Group databases combine EMBASE, CINAHL and
MEDLINE records. We identified the EMBASE records through
keyword or text word (in title or abstract fields) searches on
asthma* or on the term wheez*. In Medline and CINAHL, the
text word searches (in title or abstract fields) were made on
terms asthma* or wheez*. The MeSH searches in MEDLINE and
CINAHL were made on the following two MeSH terms: respiratory sounds and asthma. The MEDLINE records cover the period
1966 to 1998, EMBASE records span 1980 to 1998, and the earliest CINAHL records date from 1982. The main Airways Group
databases include the records downloaded from the three electronic systems. We searched the main Airways Group databases
using the following terms: placebo* OR trial* OR random* OR
double-blind OR double blind OR single-blind OR single blind
OR controlled study OR comparative study) and we exported
those records to a separate RCT register.
In addition, we identified asthma-related studies from PSYCHLIT using the Cochrane Schizophrenia Groups search strategy to
identify trials in that behavioral sciences database. We searched
this database using the following terms: asthma* OR asthma- in
DE OR wheez* OR [(bronchial*) near (hyper-reactiv* or hyperreactiv*)] AND randomi* OR [(singl* OR doubl* OR trebl* OR
tripl*) near (blind* OR mask*)] OR crossover.
Searching other resources
Finally, we hand searched the reference lists from relevant reviews that had been identified (Clark 1993; Clark 1994; BernardBonnin 1995).
Selection of studies
One reviewer screened the title and abstract of each citation that
we identified through the search strategy to determine possible
eligibility for inclusion. We then obtained the complete article
of each citation identified as eligible or possibly eligible. At least
two investigators (FW, CG, JG, MR) independently assessed each
article to determine study eligibility. Disagreement was settled by
consensus.
Studies were included if (a) they were published randomized controlled trials (RCTs) or controlled clinical trials (CCTs); (b) they
included children or adolescents ages 2 to 18 years old; (c) they had
an educational intervention designed to teach one or more selfmanagement strategies related to prevention, attack management,
or social skills; (d) they included outcomes on pulmonary function tests, morbidity, functional status, or health care utilization.
We excluded studies if they included participants with pulmonary
diagnoses other than asthma, lacked suitable control populations
for comparison, used non-standard educational interventions, or
did not report on any outcomes of interest.
In addition, if continuous outcomes were reported without standard deviations, we imputed pooled standard deviations from the
following generalized formula for the t-statistic (Rosenthal 1991):
t = [M1 - M2 / S] X [ 1/ sq root (1/n1 + 1/n2 ) ]
Where t refers to the t-statistic, M refers to the mean of the treatment and control groups, S refers to the pooled standard deviation, and n refers to the sample size of the treatment and control
groups. If the t-statistic was not reported in a given paper, the tstatistic corresponding to the exact p-value with the appropriate
degrees of freedom was used. If the t-statistic and exact p-value
were not reported in a given paper, the t-statistic corresponding
to p = 0.05 (for a reported p<0.05) or p = 0.50 (for a reported p
> 0.05) with the appropriate degrees of freedom was used.
Data synthesis
For continuous outcomes, we used the standardized weighted
mean difference (SMD) to estimate a pooled effect size, since in all
cases, outcomes were reported in different units or scales. We reported the pooled effect sizes with 95% confidence intervals (CI).
We used both a fixed-effects model (Hasselblad 1995) and a random-effects model (DerSimonian 1986) to pool the data, since
there does not appear to be general consensus as to which method
is superior. In general, the random-effects method is a more conservative approach than the fixed-effects method and results in
larger CIs.
For consistency and simplicity, We reported the SMDs based on
the fixed-effects model in the text of the review and in the table of
comparisons. Where effect sizes differed statistically, we reported
the pooled effect size from the random-effects model in footnotes
to the tables and in the text of the review. For dichotomous outcomes, we used the odds ratio (OR) with 95% CIs to estimate
a pooled effect size (Greenland 1985). We also used both fixedeffects and random-effects models to pool data on dichotomous
outcomes. We calculated the number needed to treat (NNT) to
prevent an adverse event for all statistically significant dichotomous outcomes (Altman 1998).
Where necessary, we computed standard deviations from standard
errors of the mean or confidence intervals using standard statistical
formulas (Hedges 1985; Wolf 1986).
asthma if they had mean FEV1 < 0.50 of predicted, mean PEFR
< 0.60 of predicted, or reported daily asthma symptoms. We categorized studies as moderate to severe if asthmatics with severe
asthma were enrolled in the study population and mild-moderate
otherwise.
(2) Educational program characteristics: Subgroup analyses were
performed on the effect of educational interventions by (a) intervention type (individual vs. group); (b) intensity of intervention
(single vs. multiple sessions); (c) time since enrolment (one to six
months vs. seven to twelve months vs. > twelve months); and (d)
self-management strategy (peak flow-based vs. symptom-based) to
estimate the effect of various intervention characteristics.
(3) Study quality characteristics: Subgroup analyses were performed on the effect of educational interventions by (1) trial type
(RCT vs. CCT); (2) allocation concealment (adequate vs. unclear
vs. inadequate); and (3) adequacy of follow-up (adequate vs. inadequate) to estimate the effects of study characteristics.
RESULTS
Description of studies
See: Characteristics of included studies; Characteristics of excluded
studies.
Results of the search
The search identified 318 titles and abstracts of potentially eligible studies. After preliminary review, a total of 45 randomized or
controlled clinical trials were identified from the literature search
and review of bibliographies as possibly eligible for inclusion. After review of the full text of these studies, 13 were excluded for
the following reasons: absence of a suitable control population (N
= 2), inclusion of children less than two years old (N = 2), use of
non-standard or information only educational interventions (N =
4), inclusion of children with conditions other than asthma (N =
1), and no outcomes of interest (N = 4).
Included studies
We performed subgroup analyses by stratifying studies on key patient-level, study quality, and program variables in order to estimate the magnitude of these effects.
(1) Patient characteristics: Subgroup analysis was performed on
the effect of educational interventions by asthma severity. Asthma
severity (mild-moderate vs. moderate-severe) was determined by
study self-report, examination of mean FEV1 or PEFR baseline
measurements, or chronicity of asthma symptoms at baseline (ATS
1991; NAEP 1997). Patients were determined to have severe
Outcomes assessed
Effects of interventions
AUTHOR VERIFICATION
An attempt was made to contact corresponding authors of all
studies in order to verify allocation concealment procedures and
to obtain missing data. A total of twenty authors (63%) responded
to requests for additional information.
OUTCOMES: SELF-MANAGEMENT VERSUS
USUAL CARE (N = 32 trials)
pooled due to missing data reported a significant benefit of education on general practitioner visits in one study involving 78
patients (Colland 1993) but not in three studies involving 141
patients (McNabb 1985; Rakos 1985; Szczepanski 1996). There
was no significant reduction in the number of hospitalizations
associated with education (SMD -0.08, 95% CI -0.21 to 0.05)
when the eight trials reporting complete data on this outcome were
pooled. One additional trial involving 84 patients which could not
be pooled due to missing data reported no significant reduction
in hospitalizations associated with education (Szczepanski 1996).
Moreover, there was no significant reduction in the proportion of
patients who experienced an ED visit (OR 1.30, 95% CI 0.93
to 1.84) or a hospitalization (OR 1.00, 95% CI 0.70 to 1.42)
when the six trials and four trials respectively reporting data on
these outcomes were pooled. There was significant heterogeneity
among the trials pooled for hospitalizations (Chi-square = 13.03,
p = 0.07) and ED visits (Chi-square = 19.68, p = 0.05) but not
for general practitioner visits.
SUBGROUP ANALYSES
When comparing studies by the type of intervention, both individual and group interventions demonstrated similar beneficial effects on a combined measure of lung function, self-efficacy scales,
and ED visits when compared to usual care. The reductions in
morbidity measures [days of school absence (SMD -0.20, 95% CI
-0.35 to -0.04), days of restricted activity (SMD -0.68, 95% CI 1.13 to -0.23), nights disturbed by asthma (SMD -0.86, 95% CI
-1.38 to -0.35)] and a measure of health care utilization [general
practitioner visits (SMD -0.29, 95% CI -0.56 to -0.03)] were generally stronger among trials pooled for individual interventions
as opposed to group interventions. There was a reduction in a
measure of health care utilization [hospitalizations (SMD -0.22,
95% CI -0.44 to -0.01)] that was stronger among trials pooled for
group interventions as opposed to individual interventions. However, there were no trials reporting on direct comparisons of individual versus group interventions. Two studies employed a combination of individual and group interventions (Fireman 1981;
Shields 1990), and the results from these two studies were consistent with those obtained from the other studies. Overall, the
number of trials available for individual and group comparisons
of most outcomes were relatively sparse (eg between one and three
trials).
single sessions. There were no direct comparisons of single sessions versus multiple sessions for any reported outcome, and most
outcomes were sparse after stratification by session number.
OUTCOMES: SELF-MANAGEMENT VS. USUAL CARE BY
TRIAL TYPE (N = 32 TRIALS)
When comparing studies by trial type, both RCTs and CCTs were
similar with regard to improvements in combined lung function
and self-efficacy scales and reductions in days of school absence.
CCTs were generally associated with greater reductions in certain
morbidity measures [exacerbations (SMD -0.47, 95% CI -0.90 to
-0.04), days of restricted activity (SMD -0.58, 95% CI -1.00 to 0.15), and nights disturbed by asthma (SMD -0.86, 95% CI -1.38
to -0.35)] and a measure of health care utilization [hospitalizations
(SMD -0.41, 95% CI -0.90 to 0.09)] than RCTs when studies
were stratified by trial type and pooled. Only for a single measure
of health care utilization [ED visits (SMD -0.23, 95% CI -0.36 to 0.09)] were RCTs generally stronger than CCTs after stratification
and pooling of trials.
OUTCOMES: SELF-MANAGEMENT VS. USUAL CARE BY
ADEQUACY OF ALLOCATION CONCEALMENT (N = 32
TRIALS)
When studies were compared by the adequacy of allocation concealment, studies judged to have both adequate and inadequate
concealment demonstrated similar improvements in combined
lung function and self-efficacy scales, and reductions in days of
school absence and ED visits. However, studies with inadequate
concealment generally had greater reductions in certain measures
of morbidity [exacerbations (SMD -0.47, 95% CI -0.90 to -0.04),
days of restricted activity (SMD -0.58, 95% CI -1.00 to -0.15) and
nights disturbed by asthma (SMD -0.86, 95% CI -1.38 to -0.35)]
and a measure of health care utilization [hospitalization (SMD 0.41, 95% CI -0.90 to 0.09)] than studies with adequate concealment when studies were stratified by the adequacy of allocation
concealment and pooled. Studies judged to have unclear concealment performed better than studies in either of the other two categories for some outcome measures [combine lung function (SMD
1.24, 95% CI 0.26 to 2.22), general practitioner visits (SMD 0.72, 95% CI -1.45 to 0.01), and ED visits (SMD -0.29, 95%
CI -0.47 to -0.11)] and worse than studies in either of the other
two categories for other measures [days of school absence (SMD
-0.09, 95% CI -0.22 to 0.04), days of restricted activity (SMD 0.12, 95% CI -0.47 to 0.24), nights disturbed by asthma (SMD
0.24, 95% CI -0.21 to 0.68), self-efficacy scales (SMD 0.23, 95%
CI -0.09 to 0.54), and hospitalizations (SMD -0.01, 95% CI 0.16 to 0.15)]. Studies judged to have adequate concealment had
a greater decrease in a single measure of health care utilization [the
risk of hospitalization (OR 0.41, 95% CI 0.21 to 0.81; NNT 9.0,
95% CI 6.4 to 30.5)]. Generally, most outcomes were sparse after
stratification by the adequacy of allocation concealment.
DISCUSSION
In this systematic review of 32 trials involving 3706 pediatric patients, asthma education programs compared to usual care were
found to improve measures of physiological function and self-efficacy; reduce days of school absence and days of restricted activity,
decrease emergency department utilization, and perhaps reduce
nights disturbed by asthma. However, the effects of asthma education on the average number of nights disturbed by asthma symptoms was only apparent when results were pooled using a fixedeffects model but not when a more conservative random-effects
model was employed. In addition, it was almost inevitable that
there was significant statistical heterogeneity of results for some
outcome measures (eg, nights disturbed by asthma was reported
as nights with asthma symptoms or nights of sleep interruption),
given the diversity of ways the same outcome is operationally defined and measured.
Subgroup analyses were conducted to examine the impact of patient or educational factors that may be important in the design
of interventions and good quality research. These results are best
viewed as tentative given the small number of pooled trials for
each subgroup post-stratification. In addition, since no studies
included direct comparisons of the different components of patient or educational factors, subgroup analyses were conducted to
compare the magnitude of effects for each subgroup. In general,
self-management education worked well for persons with moderate-to-severe asthma as well as for those with mild-to-moderate
asthma, although several outcomes were stronger for those with
greater asthma severity. In looking at the characteristics of the interventions, both individual and group interventions, and single
and multiple educational sessions were effective, but not necessarily for the same outcomes. Peak flow-based strategies generally
showed greater effect sizes than symptom-based strategies. In looking at the effects of the interventions by time, beneficial effects
on measures of physiological function were apparent within the
first six months following enrolment, but benefits did not become
fully apparent on measures of morbidity or health care utilization
until 7 to 12 months following enrolment.
Subgroup analyses were also conducted to look at the effects of
study design and methodological quality on outcomes. Both RCTs
and CCTs showed beneficial results but not necessarily for the
same outcomes. CCTs appeared to be associated with greater reductions in many measures of morbidity and health care utilization
than RCTs. The adequacy of allocation concealment was unclear
for a large number of studies (43%), however studies judged to
have inadequate concealment performed better on many morbidity and health care utilization measures than studies judged to have
adequate or unclear concealment. Studies with adequate followup generally showed greater effects than studies with inadequate
follow-up, however studies with inadequate follow-up were few
(23%). For four outcome measures (combined lung function, days
of school absence, self-efficacy scales, and ED visits), the effects
of self-management education were consistently as beneficial or
better among pooled studies of higher quality (eg. RCTs, adequate
concealment, adequate follow-up) than among pooled studies of
lower quality.
AUTHORS CONCLUSIONS
Implications for practice
(1) Evidence from this systematic review of existing clinical trials supports the conclusion that self-management educational interventions for children and adolescents with asthma compared
to usual care result in improved physiological function, decreased
asthma morbidity, improved self-perception, and reduced health
care utilization. The educational programs included in this review
all incorporate prevention and attack management components as
part of their interventions. A small subset of the studies included a
social skills component. The results suggest the desirability of incorporating self-management education consisting of prevention
and attack management components into routine asthma care for
children and adolescents.
(2) Evidence from this systematic review suggests that on average patients who receive self-management education would incur
moderate improvements in their physiological function over those
who receive usual care.
(3) Evidence from this systematic review suggests that on average patients who receive self-management education would have
modest reductions in school absences and days with restricted activity, and may reduce the nights in which asthma symptoms occur
compared to those who receive usual care.
(4) Evidence from this systematic review suggests that on average patients who receive self-management education would have
moderate improvements in their feelings of self-control compared
to those who receive usual care.
(5) Evidence from this systematic review suggests that on average patients who receive self-management education would incur
modest decreases in their utilization of the emergency department
compared to those who receive usual care.
(6) This systematic review found no reliable differences in the
risk or frequency of hospitalizations between usual care and care
supplemented with self-management education. These types of
more rare and serious events may be beyond the ability of education
to influence.
(7) There is not enough evidence to reliably discern differences
in the effectiveness of self-management education as a function of
differences in asthma severity or the components of educational
programs. There were no direct comparisons evaluating these differences head-to-head. However, tentative results from this review
suggest that patients with more severe asthma may derive greater
benefits from education than those with milder forms of asthma.
In addition, tentative results from this review suggest that peak
flow-based interventions may outperform symptom-based interventions. In general, benefits of education on physiological outcomes became apparent within the first six months following enrolment, but benefits of education on morbidity and health care
utilization measures did not become apparent until seven to twelve
months following enrolment.
ACKNOWLEDGEMENTS
The authors would like to thank the Cochrane Airways Collaborative Review Group Editorial Office, including Steve Milan, Anna
Bara, Jane Dennis, and Professor Paul Jones for their helpful comments and for assistance in identifying trials. We also thank Margo
Rankin for assistance with coding the data, Toby Lasserson for
his excellent translation of the Szczepanski study from German to
English, and Drs. Francine M. Ducharme and Mike McKean for
10
REFERENCES
Colland VT. Learning to cope with asthma: a behavioral selfmanagement program for children. Patient Education and
Counseling 1993;22(3):14152.
Dahl 1990 {published data only}
11
McNabb WL, Wilson-Pessano SR, Hughes GW, Scamagas P. Selfmanagement education of children with asthma: AIR WISE.
American Journal of Public Health 1985;75(10):121920.
Mitchell 1986 {published data only}
Rakos RF, Grodek MV, Mack KK. The impact of a selfadministered behavioral intervention program on pediatric asthma.
Journal of Psychosomatic Research 1985;29(1):1018.
Ronchetti 1997 {published data only}
Toelle BG, Peat JK, Salome CM, Mellis CM, Bauman AE,
Woolcock AJ. Evaluation of a community-based asthma
Whitman N, West D, Brough FK, Welch M. A study of a selfcare rehabilitation program in pediatric asthma. Health Education
Quarterly 1985;12(4):33342.
Wilson 1996 {published data only}
12
Moe EL, Ches JD, Vollmer WM, Wall MA, Stevens VJ, Hollis JF.
Implementation of Open Airways as an educational intervention
for children with asthma in an HMO. Journal of Pediatric Health
Care 1992;6:2515.
Clark 1993
Clark N, Gotsch A, Rosenstock I. Patient, professional, and public
education on behavioral aspects of asthma: a review of strategies for
change and needed research. Journal of Asthma 1993;30:24155.
Clark 1994
Clark N, Starr-Schneidkraut N. Management of asthma by patients
and families. American Journal of Respiratory and Critical Care
Medicine 1994;149:S54S66.
Clarke 1999
Clarke M, Oxman A. Cochrane Reviewers Handbook 4.0 (updated
July 1999). 4th Edition. Oxford: The Cochrane Collaboration,
1999.
Creer 1976
Creer T, Renne C, Christian W. Behavioral contributions to
rehabilitation and childhood asthma. Rehabiliation Literature 1976;
38:226.
Cunningham 1996
Cunningham J, Dockery D, Speizer F. Race, asthma, and persistent
wheeze in Philadelphia schoolchildren. American Journal of Public
Health 1996;86:14069.
DerSimonian 1986
DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled
Clinical Trials 1986;7:17788.
Additional references
Altman 1998
Altman DG. Confidence intervals for the number needed to treat.
Britich Medical Journal 1998;317:130912.
ATS 1991
American Thoracic Society. Lung function testing: selection of
reference values and interpretative strategies. American Review of
Respiratory Disease 1991;144:120218.
Bandura 1996
Bandura A. Social foundations of thought and action. Englewood
Cliffs, NJ: Prentice Hall, 1996.
Bernard-Bonnin 1995
Bernard-Bonnin A, Stachenko S, Bonin D, Charette C, Rousseau
E. Self-management teaching programs and morbidity of pediatric
asthma: a meta-analysis. Journal of Allergy and Clinical Immunology
1995;95:3441.
Clark 1986a
Clark N, Feldman C, Evans D, Levison M, Wasilewski Y, Mellins
R. The impact of health education on frequency and cost of health
care use by low income children with asthma. Journal of Allergy and
Clinical Immunology 1986;78:10815.
Clark 1986b
Clark N, Feldman C, Evans D, Duzey O, Levison M, Wasilewski Y.
Managing better: parents, children and asthma. Patient Education
and Counseling 1986;8:2738.
Clark 1989
Clark N. Asthma self-management education. Research and
implications for clinical practice. Chest 1989;95:11103.
Doull 1996
Doull I, Williams A, Freezer N, Holgate S. Descriptive study of
cough, wheeze, and school absence in childhood. Thorax 1996;51:
6301.
Gibson 1998
Gibson PG, Coughlan J, Abramson M, Bauman A, Hensley MJ,
Walters EH, Wilson AJ. The effects of self-management education
and regular practitioner revew in adults with asthma (Cochrane
Review). The Cochrane Library 1998, Issue 2.
Gibson 1999
Gibson PG, Coughlan J, Wilson AJ, Hensley MJ, Abramson M,
Bauman A, Walters EH. Limited (information only) patient
education programs for adults with asthma (Cochrane Review).
The Cochrane Library 2000, Issue 1.[Art. No.: CD001005. DOI:
10.1002/14651858.CD001005]
Greenland 1985
Greenland S, Robins J. Estimation of a common effect parameter
from sparse follow-up data. Biometrics 1985;41:5568.
Habbick 1999
Habbick B, Pizzichini M, Taylor B, Rennie D, Senthilselvan A,
Sears M. Prevalence of asthma, rhinitis, and eczema among children
in 2 canadian cities: the International Study of Asthma and
Allergies in Childhood. Canadian Medical Association Journal 1999;
160:182428.
Hasselblad 1995
Hasselblad V, Hedges L. Meta-analysis of screening and diagnostic
tests. Psychological Bulletin 1995;117:16778.
Hedges 1985
Hedges L, Olkin I. Statistical methods for meta-analysis. Orlando:
Academic Press, 1985.
13
Hindi-Alexander 1984
Hindi-Alexander M, Cropp G. Evaluation of a family asthma
program. Journal of Allergy and Clinical Immunology 1984;74:
505510.
Hurd 1992
Hurd S, Lenfant C. The National Heart, Lung, and Blood Institute
Asthma Program. Chest 1992;101:359S361S.
Lozano 1997
Lozano P, Fishman P, VonKorff M, Hecht J. Health care utilization
and cost among children with asthma who were enrolled in a health
maintenance organization. Pediatrics 1997;99:75764.
Magnus 1997
Magnus P, Jaakkola J. Secular trend in the occurrence of asthma
among children and young adults: critical appraisal of repeated
cross sectional surveys. BMJ 1997;314:17959.
McFadden 1992
McFadden E, Gilbert I. Asthma. New England Journal of Medicine
1992;327:192837.
NAEP 1997
National Asthma Education Program. Guidelines for the diagnosis
and management of asthma. Betheseda, Maryland: National
Institutes of Health, 1997.
Newacheck 2000
Newacheck P, Halfon N. Prevalence, impact, and trends in
childhood disability due to asthma. Archives of Pediatric &
Adolescent Medicine 2000;154:28793.
Ng 1999
Ng T, Tan W. Temporal trends and ethnic variations in asthma
mortality in Singapore, 1976-1995. Thorax 1999;54:9904.
Perrin 1999
Perrin J, Kuhlthau K, McLaughlin T, Ettner S, Gortmaker S.
Changing patterns of conditions among children receiving
supplemental security income disability benefits. Archives of
Pediatric & Adolescent Medicine 1999;153:804.
Rosenthal 1991
Rosenthal R. Meta-analytic procedures for social research. revised.
Newbury Park, CA: Sage Publications, 1991.
Schwarzer 1995
Schwarzer R, Fuchs R. Self-Efficacy and Health Behaviours. In:
Conner M, Norman P editor(s). Predicting Health Behaviour:
Research and Practice with Social Cognition Models. Buckingham:
Open University Press.
Senthilselvan 1998
Senthilselvan A. Prevalence of physician-diagnosed asthma in
Saskatchewan, 1981-1990. Chest 1998;114:38892.
Shamssain 1999
Shamssain M, Shamsian N. Prevalence and severity of asthma,
rhinitis, and atopic eczema: the northeast study. Archives of Disease
in Childhood 1999;81:3137.
Wilson-Pessano 1985
Wilson-Pessano S, McNabb W. The role of patient education in the
management of childhood asthma. Preventive Medicine 1985;14:
67087.
Wolf 1986
Wolf F. Meta-analysis: quantitative methods for research synthesis.
London: Sage Publications, 1986.
14
CHARACTERISTICS OF STUDIES
RCT: After a treatment conference, children were randomized into a control or clinical nurse specialist
group.
Blinded assessment: no
Assessment: Pre- and 4, 8, 12 months post-intervention.
Participants
Interventions
Description: A Clinical Nurse Specialist (CNS) counselled children and parents in the fundamental
concepts of asthma self-care.
Program topics: (1) Assessment of self-care deficit, (2) basic lung anatomy and asthma pathophysiology,
(3) review of medications, actions, potential side effects, and therapeutic usage, (4) importance of a parentrecorded daily symptom chart to assist families to gain insight into specific asthma triggers for the child,
and (5) importance of avoidance measures and environmental control (avoiding inhaled irritants and
allergens).
Setting: clinic
Session type: individual (parent & child together)
Number of sessions: 4
Session length: not reported.
Time span of intervention: 12 months.
Self-management strategy: Symptom-based. Educational Strategy: Prevention, attack management.
Instructional methods/tools: Visual aids, printed handouts.
Additional information: All subject contact with the CNS occurred in the general pediatric clinic which
met one-half day weekly under the supervision of the Pediatric Allergy Division.
Outcomes
Notes
Possible biases: Performance Bias (care may have been systematically different between CNS and continuity
clinics apart from educational intervention) and Selection bias (allocation concealment unclear).
Risk of bias
15
Alexander 1988
(Continued)
Item
Authors judgement
Description
Allocation concealment?
Unclear
Carswell 1989
Methods
RCT: Families of children with asthma were randomly allocated by computer-generated random numbers
to either receive visits by an asthma nurse or not.
Blinded assessment: Yes
Assessment: Pre- and 6 months post-enrolment.
Participants
Interventions
Description: Education program delivered by District Health Authority nurses, trained in asthma.
Program topics: (1) Asthma, (2) asthma risks, (3) treatment factors likely to provoke an attack, (4)
preventing and curtailing an attack.
Setting: home
Session type: Individual.
Number of sessions: 1 or more.
Session length: Mean time 29 minutes.
Time span of intervention: 6 mos
Self-management strategy: Peak Flow-based. Educational Strategy: Prevention, attack management.
Instructional methods/tools: Didactic.
Additional information: None
Outcomes
Notes
Risk of bias
Item
Authors judgement
Description
16
Carswell 1989
(Continued)
Allocation concealment?
Unclear
Charlton 1994
Methods
RCT: Subjects were stratified on age, gender, and previous asthma prophylaxis and then randomized to
intervention or control group using sealed envelopes containing the intervention assignment.
Blinded assessment: no.
Assessment: pre- and 12 months post-enrolment.
Participants
Interventions
Description: Nurse-led educational intervention delivered at outpatient clinic or during inpatient stay.
Program topics: (1) inhaler technique,
(2) mechanisms of asthma, 3) functions of medications, 4) self-management plan involving peak flow
meter and diary card.
Setting: clinic or hospital ward.
Session type: individual.
Number of sessions: 1
Session length: 45 minutes
time span of intervention: 1 day.
Self-management strategy: peak flow-based.
Educational strategy: prevention and attack management.
Instructional methods/tools: diary cards and didactic sessions.
Additional information: none.
Outcomes
Notes
Possible biases: selection bias (intervention group had greater proportion with severe symptoms and higher
health care visits at baseline).
performance bias (nurse consulted physicians regarding medication management for treatment group but
not for control group).
Risk of bias
Item
Authors judgement
Description
17
Charlton 1994
(Continued)
Allocation concealment?
Yes
Christiansen 1997
Methods
CCT: Subjects were assigned non-randomly in block by school site to an educational program or a control
group with schools alternating as treatment or control groups in successive years.
Blinded assessment: Not specified
Assessment: Pre- and 6 months post-intervention.
Participants
Interventions
Description: An asthma education program based on the consensus report guidelines for asthma care
published by the NHLBI and delivered by school nurses.
Program topics: (1) Basic information about asthma, identification of asthma warning signs, reduction of
asthma triggers, and use of an inhaler, (2) asthma medication (bronchodilators), (3) asthma medications
(anti-inflammatory agents), use of a peak flowmeter, development of an action plan, and development of
an emergency plan for asthma.
Setting: school
Session type: group
Number of sessions: 5
Session length: 20 minutes
Time span of intervention: 5 weeks
Self-management strategy: Peak Flow-based. Educational Strategy: prevention, attack management
Instructional methods/tools: Booklets, handouts covering the key points of each lesson, reference materials.
Additional information: Sessions held in bilingual interaction.
Outcomes
Notes
Possible biases: selection biases (schools were not randomly assigned to treatment group).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
18
Clark 1986
Methods
RCT: After initial interviews, children were randomly assigned in a 2:1 ratio either to the experimental
or control.
Blinded assessment: Yes.
Assessment: Pre- and 12 months post-enrolment.
Participants
Interventions
Description: Open Airways education program to improve asthma management at home delivered by
health educator.
Program topics: (i) Managing the asthma attack, (ii) taking medicine, (iii) communicating with the physician, (iv) improving school performance,(v) maintaining a healthy home environment, (vi) establishing
guidelines for the childs physical activities.
Setting: outpatient allergy clinic
Session type: group.
Number of sessions: 6
Session length: 60 minutes
Time span of intervention: 6 mos (1 session per month)
Self-management strategy: Symptom-based. Educational Strategy: Prevention, attack management, social
skills.
Instructional methods/tools: Group discussion including a process for problem solving led by a health
educator.
Additional information: none.
Outcomes
Notes
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
19
Colland 1993
Methods
RCT: Subjects were randomly allocated to an experimental group or one of two control groups (limited
asthma education and control).
Blinded assessment: No
Assessment: Preliminary test and evaluation post training, 6 months later, and one year later.
Participants
Interventions
Outcomes
Notes
Risk of bias
Educational interventions for asthma in children (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
20
Colland 1993
(Continued)
Item
Authors judgement
Description
Allocation concealment?
Unclear
Dahl 1990
Methods
RCT: Subjects were randomized equally into a behavioral intervention group or a non-intervention control
group.
Blinded assessment: Not specified.
Assessment: A four-week baseline period, a four-week intervention period, and a four-week follow-up
period.
Participants
Interventions
Description: Behavior therapy treatment was tailored for each child according to his/her behavior analysis
during the 4 week baseline period
Program topics: (1) discrimination training of correct asthma signals, (2)self-management techniques of
breathlessness, (3)counter-conditioning of any learned fear response to asthma symptoms, (4) contingency
management of acute asthma-related behavior for overusers of hospital facilities, (5) social skills training,
(6) medication compliance training.
Setting: childs home or school environment.
Session type: individual.
Number of sessions: 4
Session length: one hour.
Time span of intervention: 4 weeks.
Self-management strategy: Peak Flow-based. Educational Strategy: Prevention, Attack management, Social
skills.
Instructional methods/tools: Problem solving, role-playing, biofeedback training using a PFM to correctly
discriminate asthma signals, time-out techniques for over-utilizers admitted to ER/hospital, homework
assignments in between sessions.
Additional information: none.
Outcomes
Lung function: Peak expiratory flow (AM & PM). Exhalation frequency (AM & PM).
Morbidity
Functional status: Number of days of school absences, psychological status (observed panic behavior in
asthma situations), number of days in which asthma was subjectively experienced.
Health care utilization: none
Other: Number of as-needed spray doses per day.
21
Dahl 1990
(Continued)
Notes
Possible biases: Exclusion bias (10% difference in follow-up between treatment and control groups),
Selection (Subjects in intervention group appear to have more severe asthma at baseline than controls
based on school absenteeism and days experiencing symptoms).
*Pooled standard deviations were imputed for days of school absence and days of restricted activity using
the exact value of the reported t-statistic.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Deaves 1993
Methods
CCT: Subjects attending two general group practices were recruited. Subjects in one practice received the
intervention while subjects in the other served as controls.
Blinded assessment: No
Assessment: pre- and 12 months post-intervention.
Participants
Interventions
Outcomes
22
Deaves 1993
(Continued)
Notes
Possible biases: selection bias (non-randomized study in which control had greater number of days lost
from school and asthma attacks at baseline.
*Pooled standard deviations were imputed for exacerbations, days of school absence, days of restricted
activity, and nights disturbed by asthma using the t-statistic conforming to the reported p-value with
appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
Evans 1987
Methods
RCT: 12 schools were paired on ethnicity and size and one school within each pair was randomly selected
by coin toss to receive intervention, while the other served as a waiting list control.
Blinded assessment: No
Assessment: Pretest and follow-up 12 months post-intervention.
Participants
Interventions
Description: Elementary school health education program based on Open Airways Program delivered
by health educator.
Program topics: (a) basic information and feelings about asthma, (b) how to recognize and respond to
symptoms of asthma, (c) using asthma medicines and deciding when to seek help, (d) how to keep active
physically, (e) identifying and controlling triggers to asthma symptoms, and (f ) handling problems related
to asthma and school
Setting: school
Session type: Group.
Number of sessions: 6
Session length: 60 minutes
Time span of intervention: 2-3 weeks.
Self-management strategy: Symptom-based. Educational Strategy: prevention, attack management, social
skills.
Instructional methods/tools: Problem solving, role playing (in class & at home). Didactic sessions: in-
23
Evans 1987
(Continued)
class skills practice, at home practice assignments. Other: stories, games, physical and artistic.
Additional information: Physical and artistic activities were based on Piagets stage of concrete operations
for ages 8 to 11.
Outcomes
Notes
Possible biases: Selection (Authors detected baseline differences on some measured variables, notably
asthma self-management skills and behavior ratings between intervention and control group).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Fireman 1981
Methods
CCT: Subjects were sequentially assigned to either the study or the comparison group and matched for
age after an evaluation and observation by a pediatric allergist.
Blinded Assessment: No
Assessment: Pre- & 12 months post-enrolment.
Participants
Treatment: 13
assigned, 13 completed (100%).
Control: 13
assigned, 13 completed (100%).
Eligibility Criteria: Pt. population selected from a pediatric allergists office practice with a history of 6 or
more asthmatic episodes.
Asthma Severity: moderate to severe asthma based on symptom frequency.
Locale: Pittsburgh, PA, USA.
Age: range 2 to 14 yrs. Mean 7.4 years.
Gender: 21 males (81%), 5 females (19%).
Other demographics: middle income.
Interventions
Description: An educational program designed to teach self-management skills to asthmatic children and
their parents delivered by a nurse educator.
Program topics: (1) lung anatomy description,(2) review of elementary pulmonary physiology and patho-
24
Fireman 1981
(Continued)
physiology, (3) factors that can provoke asthma (i.e. allergens, infections, exercise, etc), (4) asthma drug
therapy , (5) avoidance and control of exposure to environmental allergens, (6) psycho-sociologic factors,
(7) skills in asthma self-management, (8) parental behavior to promote childs self-managment.
Setting: doctors office; reinforced with telephone follow-up.
Session type: both individual (patient & family) & group.
Session length: Individual instruction: one hour. Group: two hours.
Time span of intervention: 12 months.
Self-management Strategy: Symptom-based.Educational strategy: prevention, attack management, social
skills.
Instructional methods/tools: didactic sessions, booklet.
Additional information: none.
Outcomes
Notes
Possible biases: selection (parental educational level was higher in control group than in intervention
group).
*Pooled standard deviations were imputed for exacerbations, days of school absence, days of restricted
activity, emergency room visits, and hospitalizations using the t-statistic conforming to the reported pvalue with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
Hill 1991
Methods
RCT: Parallel group controlled intervention study: Schools were randomized by computer generated
random numbers to receive the intervention or to be a control according to their school nurse team.
Blinded assessment: Not specified
Assessment: Pre- and 6, 9, 12 months post- intervention.
Participants
25
Hill 1991
(Continued)
Description: Two part medical appraisal and teacher education program. Children suspected of undertreated asthma were asked to visit their family physician for diagnosis and treatment. Teachers from
intervention schools attended an education program on asthma taught by school nurse.
Program topics:
Medical Appraisal: Peak flow meters for assessment of symptoms, value of prophylaxis and inhalation
route of drugs
Teacher Education Session: information on asthma and correct use of inhalers.
Setting:
Medical Appraisal:doctors office/clinic
Teacher Education Session: school
Session type:
Medical Appraisal - individual.
Teacher Education Session - group
Number of sessions:
Medical Appraisal - not reported
Teacher Education Session - 63 teaching sessions were delivered to 44 intervention schools.
Session length:
Medical Appraisal - not reported
Teacher Education Session - 1 hr. during school lunch break
Time span of intervention:
Medical Appraisal - not reported
Teacher Education Session - not reported
Self-management strategy: Symptom-based.
Educational Strategy: Attack Management.
Instructional methods/tools:
Medical Appraisal - not reported
Teacher Education Session - didactic, visual aids
Additional information: Nurses giving instruction to teachers also checked children to make sure that
they were using their inhalers correctly and appropriately. Nurses checked inhaler technique of two-thirds
of children known to take inhalers to school.
Outcomes
Notes
Possible biases:
selection (Control group had greater proportion female, greater mean days of school absence, games
missed, and swimming lessons missed), performance (practitioners of intervention children were asked to
review their subjects diagnoses and modify their treatment plans according to a guideline).
Risk of bias
Item
Authors judgement
Description
26
Hill 1991
(Continued)
Allocation concealment?
Yes
Holzheimer 1998
Methods
RCT: Subjects were randomly assigned to one of three experimental groups (1. video + book, 2. video
only, 3. book only) or control group.
Blinded assessment: Yes.
Assessment: pre-test, 4 months post-test.
Participants
Treatment: 60 assigned into each of 3 treatment groups, 16 completed group 1 (80%), 13 completed
group 2 (65%), and 12 completed group 3 (60%).
Control: 20 assigned, 15 completed (75%).
Eligibility criteria: Children aged 2 to 5 yrs requiring daily medication for asthma.
Asthma severity: Not described.
Locale: Queensland, Australia
Age: Range 24 to 71 mos. Mean 48.6 mos.
Gender: not specified.
Other demographics: not specified.
Interventions
Description: An educational program consisting of Video tape Young Children Managing Asthma and
the picture book Whats That Noise?
Program topics: Need for prophylactic medications to prevent acute episodes and allow full participation in
daily activities; correct terminology for spacers and nebulizers; correct technique for delivering medication
via a spacer; appropriate use of the nebulizer to manage acute episodes; promotion of a positive attitude
towards nebulizer use; and engagement in pleasant relaxing activities while using the nebulizer.
Setting: outpatient (childrens hospital).
Session type: group.
Number of sessions: 3
Session length: Video-4 minutes
Time span of intervention: 4 mos.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management.
Instructional methods/tools: videotapes, booklets
Additional information: Group 1--asthma tape & asthma book. Group 2--asthma tape & unrelated book.
Group 3--unrelated tape & asthma book. Group 4 (control)--unrelated tape and book.
Outcomes
Notes
Possible biases: Exclusion bias (differences in follow-up between the 4 groups) and selection bias (allocation
concealment was unclear).
*Pooled standard deviations were imputed for days of restricted activity and physician visits using the tstatistic corresponding to the reported p-value with appropriate degrees of freedom.
Risk of bias
27
Holzheimer 1998
(Continued)
Item
Authors judgement
Description
Allocation concealment?
Unclear
Hughes 1991
Methods
RCT: Subjects were stratified on age group and number of previous hospitalizations and then randomly
assigned by coin toss to treatment or control groups.
Blinded assessment: No.
Assessment: Pre-intervention, intervention, and 6, 9, 12, and 24 mos. post-intervention.
Participants
Interventions
Description: Comprehensive home and ambulatory program for asthma management consisting of:
(1) Regular 3-monthly clinic visits with pediatric respirologist and nurse coordinator to outline an asthma
management (i) avoidance of triggers, (ii) promotion of exercise, (iii) proper medication use, (iv) proper
inhaler use, and (v) home management of exacerbations. and administer the asthma education program
(i) review of anatomy, (ii) acute episodes, (iii) treatments
(2) 2 home visits by nurse coordinator to evaluate environmental triggers, smoking, MDI technique, and
asthma management plan.
(3) Additional clinic or home visits and school contact as needed.
Setting: Clinic and home.
Session type: individual.
Number of sessions: 4 scheduled in clinic, 2 scheduled at home. More visits as needed.
Session length: not reported
Time span of intervention: 12 months.
Self-management strategy: Peak flow-based. Educational Strategy: prevention, attack management
Instructional methods/tools: didactic, pamphlets
Additional information: Control attended clinic at 3 mo. intervals for assessment only. Pts. in tx group
were seen by study MD or RN for emergency or inpatient care at IWK Childrens hospital.
Outcomes
Notes
Possible biases: Performance (medications and asthma plan managed by respirologists in study group and
by primary care physicians in control group).
*Pooled standard deviations were imputed for physician visits, emergency room visits, and hospitalizations
28
Hughes 1991
(Continued)
using the t-statistic corresponding to the reported p-value with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Kubly 1984
Methods
RCT: Parent-child dyads were randomly assigned by draw to treatment and control groups.
Blinded assessment: No
Assessment: Pre- and 2 mos post-enrolment.
Participants
Interventions
Description: Nursing instructional program designed to promote self-care delivered by nurse educators.
Program topics: CONTROL & TREATMENT
(1) Parents - developmental tasks of school-aged child, physiologic occurrences in asthma, myths about
asthma, overview of asthma management.
(2) Children - feelings and asthma, basic A&P related to asthma, asthma management.
TREATMENT ONLY
(A) Parents - asthma care self-care skill instruction including practice in breathing exercises and promoting
self-medication in the child.
(B) Children - instruction in breathing exercises and self-medication
Setting: school
Session type: Group.
Number of sessions: 3 to 4
Session length: 60 to 90 minutes.
Time span of intervention: 3 to 4 weeks.
Self-management strategy: symptom-based.Educational strategy: prevention and attack management.
Instructional methods/tools:
Lecture discussion format. Use of worksheets from Teaching Myself About Asthma book for discussion.
Handout How to Take Your Medicine for self-medication skill instruction.
Additional information: none.
Outcomes
29
Kubly 1984
(Continued)
Possible biases:
Exclusion bias (over 50% withdrawal in both treatment and control groups) and
Selection bias (experimental group had substantially greater mean annual emergency visits relative to
control group).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
LeBaron 1985
Methods
Participants
Interventions
Description: Educational program delivered by nurse educators to increase compliance with cromolyn.
Program topics: Demonstrations on the use of cromolyn and discussions about how, why, and when to use
cromolyn and how to anticipate problems with its use. Patients were then asked to demonstrate their use
of cromolyn. Patients received instruction in the cleaning of their Spinhaler turbo inhaler. Other issues
related to asthma were included (not reported), but the main focus was on the mechanics of cromolyn
administration.
Setting: Allergy clinic offices
Session type: Indvidual (children & parents).
Number of sessions: 3
Session length: Not reported.
Time span of intervention: 5 months.
Self-management strategy: peak flow-based. Educational strategy: prevention.
Instructional methods/tools: didactic (demonstration)
Additional information: none.
Outcomes
Lung function: Peak expiratory flow, FEV1, FEVC, FEF25 to 75, pulmonary function tests.
Morbidity: asthma severity
Functional status: wheezing episodes, activity level, exercise tolerance, night cough, need for increased
30
LeBaron 1985
(Continued)
asthma meds.
Health care utilization: none
Other: Patient symptoms: (1) patient medical history score, (2) allergist medical history score, (3)
Overall control of asthma .
Notes
Possible biases:
selection bias (allocation concealment was unclear).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Lewis 1984
Methods
RCT: Subjects were randomly assigned using a table of random numbers into control and experimental
groups.
Blinded assessment: No
Assessment: 12 mos pre- and 3, 6, and 12 mos. post-intervention.
Participants
Interventions
Description: Asthma Care Training, (ACT) educational curriculum for children and their parents.
Uses an automobile analogy and a traffic light system of colored stickers to code medication and other
techniques.
Program topics: (i) Mechanism of asthma and resultant symptoms and signs, (ii) Feelings about having
asthma and bronchospasm episodes, (iii) Environmental control and allergens, (iv) Relaxation skills,
breathing exercises, (v) review prescribed drugs with MD, (vi) Decision making skills, (vii) Concept of
balanced living.
Setting: clinic
Session type: group
Number of sessions: 5 (weekly)
Session length: 1 hour.
Time span of intervention: 5 weeks.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management, social
skills.
Instructional methods/tools: Games, role playing, simulation modelling (social learning), automobile and
31
Lewis 1984
(Continued)
Notes
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Madge 1997
Methods
RCT: Subjects were randomly assigned prior to study to intervention or control group by drawing cards.
Blinded assessment: No
Assessment: Pre- and 14 months post-intervention.
Participants
Interventions
Description: Asthma home management training program consisted of review discussion sessions, written
information, and advice, subsequent follow up and telephone advice delivered by asthma nurse.
Program topics: (i) Nature of asthma, (2) its triggers, (3) and its treatment including the use and side
effects of corticosteroids, (iv) signs commonly present in impending asthma attacks, (v) recognition of
signs in children.
Setting: Inpatient and outpatient clinic.
Session type: individual
Number of sessions: 3
Session length: total of 45 min.
Time span of intervention: 2 to 3 weeks.
32
Madge 1997
(Continued)
Notes
Possible biases: Selection (the treatment group was slightly older (6.0) compared to the control group
(4.23)).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
McNabb 1985
Methods
RCT: Subjects were paired and randomly assigned to either an experimental or control group by coin
toss.
Blinded assessment: No
Assessment: Pre- and at 12 mos post-treatment.
Participants
Interventions
33
McNabb 1985
(Continued)
Notes
Possible biases:
none
*Pooled standard deviations were imputed for emergency room visits using the t-statistic corresponding
to p=0.05 with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Mitchell 1986
Methods
RCT: Subjects stratified by ethnicity (European vs. Polynesian), then randomized into treatment and
control groups using random numbers table.
Blinded assessment: no
Assessment: 6 and 18 months post-enrolment.
Participants
Interventions
Description: Educational program for children with asthma and their families delivered by community
health nurses.
Program topics: a) lung function, pathophysiology, factors that provoke asthma, b) description of asthma
drugs, c) stimuli that provoke asthma, controlling the environment, d) drug compliance check and correct
use of aerosols, e) contacting general practitioner rather than the ER when an asthma attack does not
respond to home bronchodilator therapy.
34
Mitchell 1986
(Continued)
Notes
Possible biases:
Exclusion (9% greater follow-up in treatment than in control group), selection (greater asthma severity
in intervention group based on mean days off school and proportions with readmissions).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Parcel 1980
Methods
CCT: Schools were non-randomly assigned to intervention or waiting list control group.
Blinded assessment: no
Assessment: Pre- and 7 mos post-enrolment.
Participants
Interventions
Description: School-based educational program, designed to involve children, parents, teachers, physicians, & other health care providers.
Program topics: 5 skills for children (1) observing situations that might lead to an asthma attack, (2)
discriminating changes that would indicate a pending/actual attack, (3) communication with parents,
doctors, others what is happening just before/during an attack, (4) decision-making to take action that
prevents/stops an attack, (5) self-reliance help with asthma.
Setting: School
Session type: group
Number of sessions: 24
35
Parcel 1980
(Continued)
Notes
Possible biases: selection (treatment group slightly older with higher socioeconomic status).
*Pooled standard deviations were imputed for self-efficacy scale using t-statistic corresponding to reported
p-value with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
Non-random allocation
Perrin 1992
Methods
RCT: Subjects were randomly assigned to an intervention or control group using a random numbers table.
Subjects were allocated to treatment groups by research assistants at separate site.
Blinded assessment: no
Assessment: pre- and 1 mos post-enrolment.
Participants
Treatment: 81 assigned to both groups but number assigned to treatment unclear, 29 completed.
Control: 81 assigned to both groups, but number assigned to control unclear, 27 completed.
Eligibility criteria: ages 6-14 years, diagnosed with asthma at least 6 months prior to study, receiving
hyposensitization injections or intermittent or continuous aminophylline, cromolyn, or B-andrenergic
bronchodilators.
Asthma severity mild, moderate, and severe.
Locale: US, specific locale not reported.
Age: mean 9.3 years, range 6-14 years.
Gender:
35 (62%) male, 21 (38%) female.
Other demographics: socioeconomic status predominately middle class, 85% white, upper-middle class.
90% recruited from community pediatric practice settings.
Interventions
Description: Combined education and stress management program for children with asthma.
Program topics: Educational portion: (1) lung function, breathing, breathing control, (2) changes in lungs
related to asthma and the effects of these changes on other bodily functions and feelings. (3) methods of
prevention, treatment and how meds and other therapy changes asthma symptoms. (4) review of sessions
36
Perrin 1992
(Continued)
1 to3, discussion of exercise, long-term outcomes, growing up with asthma. Stress-Management Portion:
Relaxation training, contingency coping exercises.
Setting: clinic
Session type: group
Number of sessions: 4
Session length: 2 hours.
Time span of intervention: one month.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management.
Instructional methods/tools:
Use of balloons, anatomic models, and encouraging questions from children.
Stress management: Emphasized deep breathing through guided imagery and muscular relaxation.
Additional information: parents and children both participated.
Outcomes
Notes
Possible biases: Exclusion bias (31% were lost to follow-up but data on number of drop-outs in treatment
and control group not given) and selection bias (allocation concealment was unclear).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Persaud 1996
Methods
RCT: Subjects were randomly assigned by a random numbers chart to intervention or control group at
each of 10 participating elementary schools.
Blinded assessment:yes
Assessment: Pre-intervention and 8 weeks post-enrolment.
Participants
37
Persaud 1996
(Continued)
Interventions
Description: Individualized educational sessions conducted by school nurses to review asthma diaries;
discuss progress, symptoms, and ability to take appropriate measures to control asthma.
Program topics: (i)Self-observation (being able to observe symptoms), (ii) discrimination (being able to
notice changes that would indicate an impending attack), (iii) communication (being able to tell nurses,
parents, and physicians what was occurring before and after an attack), (iv) decision making, and v) selfreliance.
Setting: school
Session type: individual
Number of sessions: 8
Session length: 20 minutes.
Time span of intervention: 8 weeks.
Self-management strategy: peak flow-based. Educational strategy: prevention, attack management, social
skills.
Instructional methods/tools: open-ended interviews, role-playing, workbook.
Additional information: none.
Outcomes
Notes
Possible biases: Selection bias (Control group had a significantly earlier age of onset of asthma and tended
to have more asthma attacks in the preceding year).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Rakos 1985
Methods
Participants
Treatment: 20
assigned, 20 completed (100%).
Control: 23 assigned, 23 completed (100%).
Eligibility criteria: (a) ages 7 to 12 years, (b) confirmed diagnosis of asthma, (c) physician expected
continued regular contact for the next year, (d) physician screening rating between 3 to 6 on the Asthma
Severity Scale (1 = minimal, 4 = moderate, 6 = severe, 7 = severe, refractory).
Asthma severity:
moderate to severe.
Locale: Cleveland, Ohio, US.
Age: range 7 to 12 years, mean age not given.
Gender: 27 males (63%), 16 females (37%).
38
Rakos 1985
(Continued)
Description: Superstuff , a self-administered, self-help asthma knowledge and management program for
parents and children. Program includes a Parents magazine and Childrens kit.
Program topics: Asthma facts and fallacies, internal and external signals and triggers, relaxation techniques,
personal control and decision making.
Setting: home
Session type: individual.
Number of sessions: 1
Session length: not reported.
Time span of intervention: not reported.
Self-management strategy: symptom-based.Educational strategy: prevention, attack management, social
skills
Instructional methods/tools: Childrens Kit--riddles, games, toys, puzzles, signs, stickers, dolls, paper cut
outs, records. Parents Magazine--29 articles covering the same material as the childrens kit.
Additional information: none.
Outcomes
Notes
Possible biases:
Selection (control subjects improving more than intervention subjects at baseline).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Ronchetti 1997
Methods
RCT: Subjects randomly assigned to intervention or control after stratification and pairing by age, gender,
and asthma severity.
Blinded assessment: no
Assessment: pre- and 11 and 12 mos post-intervention.
Participants
39
Ronchetti 1997
(Continued)
Interventions
Description: Two asthma education programs (Living with Asthma and Open Airways) delivered by
physicians.
Program topics: i) Lung anatomy, ii) asthma patho-physiology, iii) trigger factors, iv) warning signs and
symptoms of asthma attacks, v) how to deal with attacks, vi) how to rationalize use of emergency rooms,
and vii) how to reduce the social consequences of asthma.
Setting: Outpatient (asthma clinic)
Session type: group
Number of sessions: 4-8
Session length: 1 hour.
Time span of intervention: 4-8 weeks.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management, social
skills.
Instructional methods/tools: written diaries, group sharing of problems, and group solutions.
Additional information: none.
Outcomes
Notes
Possible biases: exclusion bias (only 67% of enrollees completed the program).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Rubin 1986
Methods
RCT: Subjects were randomly assigned with the aid of a random number table to the experimental or
control group.
Blinded assessment: yes.
Assessment: pre- and 12 months post-enrolment.
Participants
40
Rubin 1986
(Continued)
Other demographics:
ethnicity, white 67%.
Socioeconomic status: lower.
Interventions
Description: Educational intervention for children using an interactive, asthma-specific computer game,
Asthma Command.
Program topics: (1) recognition of symptoms & allergens, (2) appropriate use of medications, (3) appropriate use of the emergency room and the physicians office, (4) encouragement of school attendance.
Setting: outpatient clinic.
Session type: Individual.
Number of sessions: 6
Session length: 45 minutes.
Time span of intervention: 10 months.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management.
Instructional methods/tools: computer assisted instruction (40 minutes) and didactic, verbal information
about asthma management (5 to 10 minutes).
Additional information: none.
Outcomes
Notes
Possible biases: Exclusion bias (15% more subjects in control dropped out than in the treatment group)
and selection bias (allocation concealment was unclear).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Shields 1990
Methods
RCT: Subjects were randomly assigned using a table of random numbers to the experimental or control
group.
Blinded assessment: yes
Assessment: Pre- and 12 and 29 months post-intervention.
Participants
41
Shields 1990
(Continued)
Other demographics: 80% black, median income 6% less than overall city median income.
Interventions
Description: An educational program for parents and children delivered by nurse clinicians. Two part
approach, part one, classes for patients & parents. Part two, telephone instruction by protocol to patients
or parents.
Program topics: (i) attack prevention, (ii) medication management, (iii) intervention during an attack,
(iv) utilization of health care resources.
Setting: classes were at HMO while telephone instruction was at home.
Session type: Group for classes. Individual for telephone.
Number of sessions: Classes 4, telephone at least 4.
Session length: Classes 1.5 hours, telephone about 30 minutes.
Time span of intervention: Not clear, but methods suggest 1 to 2 months.
Self-management strategy: symptom-based. Educational strategy: prevention, attack management.
Instructional methods/tools: didactic, telephone reinforcement.
Additional information: none.
Outcomes
Notes
Possible biases:
None.
*Pooled standard deviations were imputed for emergency room visits using t-statistic corresponding to p=
0.50 (NS) with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Yes
Szczepanski 1996
Methods
CCT: Families of children with asthma were randomized to one of two education interventions. Control
group included families who were adequately treated by their doctors.
Blinded assessment: no.
Assessments: pre-, 6, and 12 months post-enrolment.
Participants
42
Szczepanski 1996
(Continued)
Description: A medical and family centered program to take into account individual family member
resources, relationships, generation gaps, socioeconomic status, and family rules. Confidence in management was at the core of the program along with self-evaluation using peak flow measurements and
symptom control. Individual delivering intervention was unclear.
Setting: asthma clinic.
Session type: group.
Number of sessions: 11+.
Session length: not reported.
Time span of intervention: 6 months.
Self-management strategy: peak flow-based.
Educational strategy: prevention and attack management.
Instructional methods/tools: lectures, problem-solving.
Additional information: none.
Outcomes
Notes
Possible biases: selection (control group was handpicked), performance (individuals assigned to intervention with follow-up received care in asthma clinic while controls received care from their own doctors)
, and exclusion (24% difference in follow-up between intervention with follow-up and control groups)
biases.
Study published in German language publication.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
Non-randomised allocation
Talabere 1993
Methods
RCT: Subjects were randomly assigned using block randomization by age, gender, and race.
Blinded assessment: none.
Assessments: 3 and 12 months pre- and 3 months post-enrolment.
Participants
43
Talabere 1993
(Continued)
Interventions
Description: asthma education program delivered by registered nurses with previous experience in asthma
education who completed formal training in intervention. Program delivered to children while in hospital
or at home. Program topics include (1) anatomy and physiology of asthma, (2) triggers and avoidance, (3)
early warning signs, (4) medication effects, (5) breathing exercises and inhaler technique, (6) management
of asthma episode, (7) feeling of parent and child, (8) school concerns, (9) support groups and camps.
Setting: home or hospital.
Session type: individual.
session length: 1 hour.
Number of sessions: 2.
Time span of intervention: 1 week.
Self-managment strategy: symptom-based.
Educational strategy: prevention, attack management, and social skills.
Instructional methods/tools: problem solving, didactic, booklets and handouts, games.
additional information: none.
Outcomes
Notes
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
Toelle 1993
Methods
CCT: Children attending randomly selected schools in one city district were invited to participate. Children in a similar district served as controls.
Blinded assessment: no
Assessment: baseline, 3 and 6 months post intervention.
Participants
44
Toelle 1993
(Continued)
Interventions
Description: Educational program to provide information and develop skills necessary for management
of the childs asthma by both parent and child, physicians and pharmacists, and community nurses and
teachers.
Program topics: (1) mechanisms of asthma, (2) possible triggers of an asthma attack, (3) the mode of
action of asthma treatment medications, (4) Inhalation techniques assessed and corrected as needed. (5)
emphasized importance of monitoring airway function and using a written management plan based on
readings, (6) an overview of the management plan was given to discuss with family doctor.
Setting: childs school
Session type: group
Number of sessions: 2
Session length: 2 hours.
Time span of intervention: one week.
Self-management strategy: peak flow-based. Educational strategy: prevention, attack management.
Instructional methods/tools: didactic sessions, skills assessment and practice, booklets.
Additional information: Subjects physicians, local pharmacists were invited to attend. Physicians who
attended were given a suggested management plan for his/her patient. In the intervention area all community nurses at local health centers and school teachers received an in-service education session at their
workplace. All families, children, physicians, & pharmacists who did not attend received the education
materials by mail.
Outcomes
Lung function: FEV1, bronchial responsiveness to histamine measured as dose-response ration (DRR)
and PD20FEV1, airflometer variability.
Morbidity: wheezing episodes, school absences, night cough.
Functional status: symptoms limiting activity.
Health care utilization: unscheduled doctor visits and ER visits.
Other: none.
Notes
Possible biases: selection (intervention group had significantly more symptoms of wheeze and night cough
at baseline than control group); performance (intervention consisted of patient education and physician
management suggestions).
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
No
Non-randomised allocation
Weingarten 1985
Methods
RCT: Children randomly assigned to experimental and control groups using a random numbers list.
Another group of children receiving only psychological assistance served as a further control.
Blinded assessment: No
Assessment: Pre- & 10 weeks post-enrolment.
Participants
Treatment: 11
assigned, 10 completed (91%).
Control: 9
assigned, 9 completed (100%).
45
Weingarten 1985
(Continued)
Eligibility criteria: Asthmatic children, ages 5 to 14 identified from the diagnostic register of a large family
practice clinic.
Asthma severity: not specified.
Locale: Rosh Haayin, Israel.
Age: 8 to 11 range, no mean given.
Gender: 21 boys (62%), 13 girls (38%).
Other demographics: Jews of Yemenite origin.
Interventions
Description: A multidisciplinary, non-pharmaceutical asthma management program delivered by physiotherapists, psychologists, and social workers.
Program topics: Physiotherapist--(1) behavior during an attack to decrease bronchospasm, (2) improving
lung ventilation and chest expansion, (3) clearance of bronchial secretions, (4) exercises for px fitness.
Psychologist: (1) relaxation during attacks, (2) reducing the feeling of helplessness, (3) mastering selfcontrol to lessen the emotional factors (fear) by means of ventilation. Social worker: (1) identify and
understand family behaviors and feelings connected with asthma, (2) the difficulties of an acute attack,
(3) searching ways of coping.
Setting: family practice clinic.
Session type: group.
Number of sessions:
Physiotherapist = 12; Social worker = 10; Psychologist = 4.
Session length:
Physiotherapist = 60 minutes, 2x/week; Psychologist = 30 minutes;
Social worker = 2 hr, 1x/week.
Time span of intervention: 10 weeks.
Self-management strategy: peak flow-based. Educational strategy: Prevention, attack management, and
social skills.
Instructional methods/tools: drawing, role-play, sculpting, childrens literature, relaxation exercises.
Additional information: none.
Outcomes
Notes
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
46
Whitman 1985
Methods
RCT: Subjects were paired after stratification on age group, gender, disease severity, and season of worst
asthma and randomly assigned to the study or control group.
Blinded assessment: No
Assessment: pre-, immediately post- and 3 months post-intervention.
Participants
Interventions
Outcomes
Notes
Possible biases: Selection bias (intervention group had more asthma episodes and fewer days of severe
asthma than control group prior to intervention).
*Pooled standard deviations were imputed for exacerbations and self-efficacy scales using t-statistic corresponding to reported p-value with appropriate degrees of freedom.
Risk of bias
Item
Authors judgement
Description
Allocation concealment?
Unclear
47
Wilson 1996
Methods
RCT: Subjects were stratified based on age group, number of medical visits for asthma in the past year,
ever hospitalized or not, and whether ever treated with corticosteroids or not and then randomly assigned
using randomly ordered consecutively numbered sealed envelopes containing group assignment to an
intervention or control group.
Blinded assessment: no
Assessment: Pre- and 3 months post-enrolment.
Participants
Interventions
Description: Wee Wheezer program, an educational program targeted to parents of preschool age children
with asthma, was administered by nurses.
Program topics: (1) Basic concepts of asthma, (2) development of action plan for asthma management,
(3) lung physiology, (4) changes in lungs during and following asthma attack, (5) asthma medications,
(6) trigger avoidance, (7) communication
with medical personnel. Setting: not stated.
Session type: group
Number of sessions: 4
Session length: 2 hours.
Time span of intervention: 4 weeks.
Self-management strategy: peak flow-based. Educational strategy: prevention, attack management, and
social skills.
Instructional methods/tools: videotapes, booklets, didactic sessions, problem-solving, and written asthma
action plan.
Additional information: the control families were crossed over and offered the basic educational program
after the 3-month follow-up assessment.
Outcomes
Notes
Possible biases: Selection (Intervention group had fewer symptom free days and parental nights of sleep
interruption at baseline).
Risk of bias
48
Wilson 1996
(Continued)
Item
Authors judgement
Description
Allocation concealment?
Yes
* Pooled standard deviations were imputed for outcomes with missing variance estimates for Dahl 1990, Deaves 1993, Fireman 1981,
Holzheimer 1998, Hughes 1991, Lewis 1984, McNabb 1985, Parcel 1980, Shields 1990, Weingarten 1985, and Whitman 1985.
Study
Aleman 1992
Subjects included children with conditions other than asthma, eg. rhinitis.
Brazil 1997
Absence of suitable control population. The study compared an in-patient educational program with an outpatient day camp program.
Brook 1993
Carson 1991
No outcomes of interest. Children and parents were evaluated on knowledge, behavioral assessment, parental
coping, family stress, and family cohesion
Gibson 1998
Indinnimeo 1987
No outcomes of interest. Children and parents were evaluated on their knowledge of asthma.
Kotses 1991
Lewis 1994
Absence of suitable control population. Trial was terminated 3 months into study after it became apparent to
study investigators that medical care was inadequate to support investigation of adjuvant educational intervention.
Mesters 1995
Moe 1992
No outcomes of interest. Study measured participants attendance and satisfaction with the intervention.
Sly 1975
Smith 1986
No outcomes of interest. Subjects were evaluated on their compliance with treatment and knowledge of asthma.
49
No. of
studies
No. of
participants
4
1
3
2
5
1
16
1
6
1
258
110
148
363
338
114
1633
79
379
103
3
6
4
6
6
12
4
8
202
360
212
619
904
1114
679
928
Statistical method
Effect size
No. of
studies
4
4
2
2
5
2
3
1
1
16
7
9
1
1
1
6
No. of
participants
258
363
88
250
114
593
1040
89
79
Statistical method
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Effect size
Subtotals only
0.50 [0.25, 0.75]
Subtotals only
1.43 [0.94, 2.18]
Subtotals only
-0.01 [-0.43, 0.41]
-0.28 [-0.53, -0.03]
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.09 [-0.25, 0.07]
-0.16 [-0.29, -0.04]
-0.24 [-0.66, 0.18]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
50
2
4
1
50
329
1
3
103
2
1
6
3
3
4
4
1
6
139
63
1
4
1
6
3
3
1
12
3
9
1
4
1
3
2
8
2
6
2
31
499
89
124
236
212
89
409
495
89
200
914
89
368
311
457
418
510
457
No. of
studies
4
4
2
1
1
5
4
1
No. of
participants
258
104
259
275
63
Statistical method
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Effect size
Subtotals only
0.50 [0.25, 0.75]
Subtotals only
3.04 [1.27, 7.25]
1.12 [0.69, 1.83]
Subtotals only
-0.20 [-0.44, 0.04]
-0.26 [-0.76, 0.24]
51
1
1
16
8
8
1
1
6
4
2
1
114
501
1132
79
297
82
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.22 [-0.40, -0.04]
-0.10 [-0.22, 0.02]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
-0.18 [-0.41, 0.05]
-0.68 [-1.13, -0.23]
Subtotals only
1
3
103
2
1
6
1
123
79
36
324
4
3
162
Subtotals only
-0.04 [-0.35, 0.27]
50
Subtotals only
6
4
451
168
6
4
440
Subtotals only
0.88 [0.55, 1.43]
464
12
4
281
Subtotals only
-0.15 [-0.39, 0.08]
833
4
2
290
Subtotals only
0.41 [0.21, 0.81]
389
8
2
131
Subtotals only
-0.15 [-0.50, 0.20]
52
16.2 Symptom-based
Strategies
797
No. of
studies
4
3
1
2
1
1
5
2
1
2
1
1
16
8
7
1
1
1
6
3
2
1
No. of
participants
172
86
104
259
199
26
113
114
649
958
26
79
271
82
26
Statistical method
Effect size
Subtotals only
0.52 [0.21, 0.83]
0.47 [0.04, 0.90]
Subtotals only
3.04 [1.27, 7.25]
1.12 [0.69, 1.83]
Subtotals only
-0.10 [-0.38, 0.18]
-1.06 [-1.89, -0.23]
Subtotals only
1
3
103
2
1
6
3
3
4
1
3
6
139
63
2
3
192
222
220
140
42
170
53
205
6
1
4
1
114
585
205
Subtotals only
0.86 [0.41, 1.82]
1.44 [0.90, 2.31]
1.49 [0.75, 2.95]
12
5
5
2
673
210
231
Subtotals only
-0.20 [-0.36, -0.04]
-0.49 [-0.77, -0.21]
0.00 [-0.26, 0.26]
Subtotals only
0.90 [0.62, 1.29]
Subtotals only
-0.22 [-0.44, -0.01]
0.04 [-0.13, 0.21]
-0.79 [-1.59, 0.01]
4
4
8
3
4
1
679
374
528
26
No. of
studies
4
1
3
2
2
5
4
1
1
1
16
3
13
1
1
6
5
1
1
No. of
participants
86
172
363
275
63
114
546
1087
79
316
63
Statistical method
Effect size
Subtotals only
0.47 [0.04, 0.90]
0.52 [0.21, 0.83]
Subtotals only
1.43 [0.94, 2.18]
Subtotals only
-0.20 [-0.44, 0.04]
-0.26 [-0.76, 0.24]
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.20 [-0.37, -0.03]
-0.10 [-0.22, 0.02]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
Not estimable
-0.61 [-1.12, -0.11]
Subtotals only
1
3
103
2
1
139
63
54
10 Self-Efficacy Scale
10.1 Multiple Sessions
11 Asthma Severity Scale
11.1 Multiple Sessions
12 General Practitioner visits
(mean)
12.1 Multiple Sessions
12.2 Single Sessions
13 ED Visit (% patients)
13.1 Multiple Sessions
14 ED Visits (mean)
14.1 Multiple Sessions
15 Hospitalization (% patients)
15.1 Multiple sessions
16 Hospitalizations (mean)
16.1 Multiple Sessions
6
6
4
4
6
5
1
6
6
12
12
4
4
8
8
360
212
540
79
904
1114
679
928
Subtotals only
0.36 [0.15, 0.57]
Subtotals only
-0.15 [-0.43, 0.12]
Subtotals only
No. of
studies
4
2
2
2
1
1
5
3
2
1
1
16
12
4
1
1
6
4
2
1
No. of
participants
106
152
104
259
249
89
114
1388
245
79
290
89
Statistical method
Effect size
Subtotals only
0.59 [0.20, 0.99]
0.44 [0.11, 0.76]
Subtotals only
3.04 [1.27, 7.25]
1.12 [0.69, 1.83]
Subtotals only
-0.12 [-0.37, 0.13]
-0.47 [-0.90, -0.04]
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.13 [-0.23, -0.02]
-0.20 [-0.45, 0.06]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
-0.20 [-0.43, 0.04]
-0.58 [-1.00, -0.15]
Subtotals only
1
3
103
2
1
6
5
139
63
256
55
10.2 CCT
11 Asthma Severity Scale
11.1 RCT
11.2 CCT
12 General Practitioner visits
(mean)
12.1 RCT
13 ED Visit (% patients)
13.1 RCT
13.2 CCT
14 ED Visits (mean)
14.1 RCT
14.2 CCT
15 Hospitalization (% patients)
15.1 RCT
16 Hospitalizations (mean)
16.1 RCT
16.2 CCT
1
4
3
1
6
104
6
6
5
1
12
9
3
4
4
8
6
2
619
170
42
790
114
932
182
679
860
68
No. of
studies
No. of
participants
4
1
86
Subtotals only
0.47 [0.04, 0.90]
152
20
2
1
104
Subtotals only
3.04 [1.27, 7.25]
259
5
1
161
Subtotals only
-0.18 [-0.49, 0.13]
88
89
1
1
114
Subtotals only
0.78 [0.36, 1.66]
16
6
521
Subtotals only
-0.18 [-0.36, -0.01]
Statistical method
Effect size
56
867
245
1
1
79
Subtotals only
2.51 [0.61, 10.29]
6
1
161
Subtotals only
-0.27 [-0.58, 0.05]
129
89
Subtotals only
Subtotals only
1
1
103
3
1
60
79
63
6
2
90
Subtotals only
0.51 [0.09, 0.93]
166
104
4
1
89
Subtotals only
0.20 [-0.21, 0.62]
81
42
Subtotals only
6
5
588
31
6
4
531
Subtotals only
1.13 [0.72, 1.79]
259
57
114
12
5
420
Subtotals only
-0.16 [-0.35, 0.04]
512
182
4
2
290
Subtotals only
0.41 [0.21, 0.81]
389
8
4
695
Subtotals only
-0.01 [-0.16, 0.15]
68
165
No. of
studies
4
4
2
1
1
5
5
1
1
16
13
3
1
1
6
5
1
1
1
3
No. of
participants
258
104
259
338
114
914
719
79
348
31
103
Statistical method
Effect size
Subtotals only
0.50 [0.25, 0.75]
Subtotals only
3.04 [1.27, 7.25]
1.12 [0.69, 1.83]
Subtotals only
-0.21 [-0.43, 0.01]
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.16 [-0.29, -0.03]
-0.11 [-0.26, 0.04]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
-0.29 [-0.51, -0.08]
-0.24 [-0.95, 0.47]
Subtotals only
58
3
6
5
1
4
4
6
202
4
2
6
5
1
12
11
1
4
3
1
8
7
1
534
85
306
54
212
645
259
905
209
311
368
560
368
No. of
studies
4
2
1
1
2
1
1
5
1
3
1
1
1
16
2
10
4
1
1
6
1
2
No. of
participants
196
42
20
104
259
161
127
50
114
318
848
467
79
161
110
Statistical method
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Odds Ratio (M-H, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Std. Mean Difference (IV, Fixed, 95% CI)
Effect size
Subtotals only
0.47 [0.18, 0.75]
0.35 [-0.28, 0.99]
1.24 [0.26, 2.22]
Subtotals only
3.04 [1.27, 7.25]
1.12 [0.69, 1.83]
Subtotals only
-0.18 [-0.49, 0.13]
-0.26 [-0.61, 0.10]
-0.18 [-0.74, 0.37]
Subtotals only
0.78 [0.36, 1.66]
Subtotals only
-0.02 [-0.24, 0.20]
-0.24 [-0.37, -0.10]
-0.03 [-0.22, 0.15]
Subtotals only
2.51 [0.61, 10.29]
Subtotals only
-0.27 [-0.58, 0.05]
0.01 [-0.37, 0.39]
59
3
1
108
1
3
103
2
1
6
3
3
4
2
1
1
6
123
79
2
1
3
6
2
1
3
12
1
7
4
4
2
2
8
5
3
143
161
315
128
232
131
31
50
125
114
665
114
499
501
110
569
254
674
60
Analysis 1.1. Comparison 1 Self-management vs. Usual Care, Outcome 1 Lung Function.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
60
2.13 (0.51)
50
1.9 (0.47)
Weight
IV,Fixed,95% CI
1 FEV1
Toelle 1993
60
50
43.6 %
43.6 %
43
109 (19)
43
100 (19)
34.3 %
Christiansen 1997
27
331.37 (53.52)
15
313.53 (40.63)
15.6 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
6.6 %
81
67
56.4 %
117
100.0 %
141
-4
-2
Favours control
Favours education
61
Analysis 1.2. Comparison 1 Self-management vs. Usual Care, Outcome 2 Exacerbations (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
64/133
57/126
84.0 %
48/60
25/44
16.0 %
193
170
100.0 %
Mitchell 1986
Toelle 1993
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
Analysis 1.3. Comparison 1 Self-management vs. Usual Care, Outcome 3 Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
3.1 (2.06)
19.0 %
68
11.8 (16.5)
47.6 %
1.5 (4.1)
13
6 (4.1)
6.8 %
25
6.68 (18.67)
25
10.04 (17.13)
15.1 %
19
6.26 (8.08)
19
4.47 (8.08)
11.5 %
100.0 %
Mean(SD)
Mean(SD)
Deaves 1993
32
2.56 (2.06)
31
Evans 1987
93
9 (14.7)
Fireman 1981
13
Talabere 1993
Whitman 1985
182
IV,Fixed,95% CI
IV,Fixed,95% CI
156
-10
-5
Favours education
10
Favours control
62
Analysis 1.4. Comparison 1 Self-management vs. Usual Care, Outcome 4 School Absences (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
100.0 %
63
51
100.0 %
Toelle 1993
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
Analysis 1.5. Comparison 1 Self-management vs. Usual Care, Outcome 5 School Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Charlton 1994
42
2.1 (11.4)
37
4.7 (15.5)
4.9 %
Christiansen 1997
27
2.39 (2.9)
15
2.98 (3.29)
2.4 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
4.7 %
0.8 (0.32)
10
0.9 (0.32)
1.2 %
32
3.69 (4.8)
31
5.19 (4.8)
3.9 %
117
19.4 (13.9)
87
19.7 (12.6)
12.4 %
13
0.5 (5.06)
13
4.6 (5.06)
1.5 %
211
5.43 (4.07)
193
6.23 (4.72)
24.9 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
5.4 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
16.1 %
Dahl 1990
Deaves 1993
Evans 1987
Fireman 1981
Hill 1991
IV,Fixed,95% CI
-1
-0.5
Favours education
0.5
IV,Fixed,95% CI
Favours control
(Continued . . . )
63
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
3.5 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
2.2 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
3.3 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
3.0 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
7.0 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
3.6 %
100.0 %
867
IV,Fixed,95% CI
(. . . Continued)
Std. Mean Difference
IV,Fixed,95% CI
766
-1
-0.5
Favours education
0.5
Favours control
Analysis 1.6. Comparison 1 Self-management vs. Usual Care, Outcome 6 Restricted Activity (% Patients).
Review:
Study or subgroup
Toelle 1993
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
8/43
3/36
100.0 %
43
36
100.0 %
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
64
Analysis 1.7. Comparison 1 Self-management vs. Usual Care, Outcome 7 Restricted Activity (Mean Days).
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
45
2.27 (4.87)
34
1.79 (3.58)
21.2 %
5.9 (1.86)
10
7.7 (1.86)
4.6 %
Deaves 1993
32
1.41 (1.63)
31
2.42 (1.63)
16.4 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
42.6 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
6.9 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
8.4 %
208
100.0 %
Colland 1993
Dahl 1990
IV,Fixed,95% CI
IV,Fixed,95% CI
171
-4
-2
Favours education
Favours control
Analysis 1.8. Comparison 1 Self-management vs. Usual Care, Outcome 8 Nights Nocturnal Asthma (%
Patients).
Review:
Study or subgroup
Toelle 1993
Education
Control
n/N
n/N
Odds Ratio
Weight
22/59
21/44
100.0 %
59
44
100.0 %
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
65
Analysis 1.9. Comparison 1 Self-management vs. Usual Care, Outcome 9 Nights Nocturnal Asthma.
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
40.2 %
Deaves 1993
32
2.16 (1.99)
31
3.9 (1.99)
29.9 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
29.9 %
100.0 %
109
IV,Fixed,95% CI
IV,Fixed,95% CI
93
-4
-2
Favours education
Favours control
Analysis 1.10. Comparison 1 Self-management vs. Usual Care, Outcome 10 Self-efficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Colland 1993
48
42.72 (3.47)
30
40.28 (3.99)
20.3 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
29.3 %
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
10.1 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
14.9 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
14.5 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
10.9 %
100.0 %
192
IV,Fixed,95% CI
IV,Fixed,95% CI
168
-4
-2
Favours control
Favours education
66
Analysis 1.11. Comparison 1 Self-management vs. Usual Care, Outcome 11 Asthma Severity Score.
Review:
Study or subgroup
Education
Control
Weight
4.36 (2.21)
17.9 %
45
2.04 (0.88)
43.3 %
-8.87 (1.64)
16
-8.81 (2.46)
15.2 %
-49.68 (6.87)
25
-45.86 (7.57)
23.6 %
100.0 %
Mean(SD)
Mean(SD)
Christiansen 1997
27
2.87 (2.34)
15
Hughes 1991
44
2.23 (0.96)
LeBaron 1985
15
Talabere 1993
25
111
IV,Fixed,95% CI
IV,Fixed,95% CI
101
-4
-2
Favours education
Favours control
Analysis 1.12. Comparison 1 Self-management vs. Usual Care, Outcome 12 General Practitioner Visits.
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Charlton 1994
42
2.3 (8.1)
37
2 (7.4)
12.9 %
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
25.8 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
4.7 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
14.2 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
8.6 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
33.7 %
100.0 %
325
IV,Fixed,95% CI
IV,Fixed,95% CI
294
-4
-2
Favours education
Favours control
67
Analysis 1.13. Comparison 1 Self-management vs. Usual Care, Outcome 13 ED Visits (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
Hughes 1991
13/44
11/45
13.4 %
Madge 1997
7/96
7/105
10.8 %
Mitchell 1986
26/133
10/126
14.4 %
Persaud 1996
4/18
9/18
12.2 %
Shields 1990
24/101
18/104
23.6 %
Toelle 1993
36/63
31/51
25.6 %
455
449
100.0 %
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
68
Analysis 1.14. Comparison 1 Self-management vs. Usual Care, Outcome 14 ED Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Alexander 1988
11
0.6 (0.9)
10
2.4 (2.1)
1.7 %
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
3.7 %
159
1.72 (4.2)
73
2.49 (6.26)
19.0 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
2.3 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
8.4 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
6.5 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
1.1 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
3.2 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
19.5 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
19.4 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
4.5 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
10.7 %
100.0 %
Clark 1986
630
IV,Fixed,95% CI
IV,Fixed,95% CI
484
-4
-2
Favours education
Favours control
69
Analysis 1.15. Comparison 1 Self-management vs. Usual Care, Outcome 15 Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
1/11
4/10
6.1 %
Hughes 1991
15/44
9/45
9.4 %
Madge 1997
8/96
26/105
36.4 %
55/178
45/190
48.1 %
329
350
100.0 %
Alexander 1988
Mitchell 1986
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
70
Analysis 1.16. Comparison 1 Self-management vs. Usual Care, Outcome 16 Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
Mean(SD)
Mean(SD)
Alexander 1988
11
0.09 (0.3)
10
0.6 (0.84)
2.2 %
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
4.4 %
175
0.11 (0.43)
81
0.21 (0.85)
25.2 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
2.7 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
10.1 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
7.9 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
41.8 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
5.7 %
100.0 %
Clark 1986
521
IV,Fixed,95% CI
IV,Fixed,95% CI
407
-1
-0.5
Favours education
0.5
Favours control
71
Analysis 2.1. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 1 Lung
Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Carswell 1989
43
109 (19)
43
100 (19)
34.3 %
Christiansen 1997
27
331.37 (53.52)
15
313.53 (40.63)
15.6 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
43.6 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
6.6 %
1 Mos 1-6
-4
-2
Favours control
Favours education
Analysis 2.2. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 2
Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
64/133
57/126
84.0 %
48/60
25/44
16.0 %
M-H,Fixed,95% CI
1 Mos 1-6
Mitchell 1986
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
72
Analysis 2.3. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
56.9 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
43.1 %
100.0 %
1 Mos 1-6
44
44
32
2.56 (2.06)
31
3.1 (2.06)
25.9 %
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
64.9 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
9.2 %
100.0 %
138
112
-4
-2
Favours education
Favours control
Analysis 2.4. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 4 School
Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mos 1-6
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
73
Analysis 2.5. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 5 School
Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
0.8 (0.32)
10
0.9 (0.32)
3.2 %
133
7.92 (16.48)
126
8.48 (26.69)
43.9 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
9.5 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
6.1 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
8.3 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
19.1 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
9.9 %
100.0 %
1 Mos 1-6
Dahl 1990
Mitchell 1986
307
286
42
2.1 (11.4)
37
4.7 (15.5)
7.7 %
Christiansen 1997
27
2.39 (2.9)
15
2.98 (3.29)
3.8 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
7.5 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
6.1 %
117
19.4 (13.9)
87
19.7 (12.6)
19.6 %
13
0.5 (5.06)
13
4.6 (5.06)
2.3 %
211
5.43 (4.07)
193
6.23 (4.72)
39.4 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
8.5 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
5.2 %
100.0 %
Evans 1987
Fireman 1981
Hill 1991
560
480
-1
-0.5
Favours education
0.5
Favours control
(Continued . . . )
74
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
44
9.8 (7.6)
45
12.2 (11.7)
Weight
IV,Fixed,95% CI
(. . . Continued)
Std. Mean Difference
IV,Fixed,95% CI
3 Mos 13-24
Hughes 1991
44
45
100.0 %
100.0 %
-1
-0.5
Favours education
0.5
Favours control
Analysis 2.6. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 6
Restricted Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mos 1-6
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
75
Analysis 2.7. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 7
Restricted Activity (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
5.9 (1.86)
10
7.7 (1.86)
35.2 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
64.8 %
25
100.0 %
1 Mos 1-6
Dahl 1990
25
45
2.27 (4.87)
34
1.79 (3.58)
24.3 %
Deaves 1993
32
1.41 (1.63)
31
2.42 (1.63)
18.9 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
49.0 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
7.9 %
100.0 %
183
146
-4
-2
Favours education
Favours control
76
Analysis 2.8. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 8 Nights
Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mos 1-6
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 2.9. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 9 Nights
Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
57.4 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
42.6 %
100.0 %
100.0 %
100.0 %
1 Mos 1-6
77
62
32
2.16 (1.99)
32
31
3.9 (1.99)
31
-4
-2
Favours education
Favours control
77
Analysis 2.10. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 10 SelfEfficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
28.5 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
40.8 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
30.7 %
100.0 %
1 Mos 1-6
62
62
48
42.72 (3.47)
30
40.28 (3.99)
31.4 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
45.4 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
23.2 %
100.0 %
130
106
-4
-2
Favours control
Favours education
78
Analysis 2.11. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 11
Asthma Severity Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
17.9 %
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
43.3 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
15.2 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
23.6 %
100.0 %
100.0 %
100.0 %
1 Mos 1-6
111
101
44
44
2.07 (1.62)
45
2.22 (0.97)
45
-4
-2
Favours education
Favours control
79
Analysis 2.12. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 12
General Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
16
Weight
IV,Fixed,95% CI
1 Mos 1-6
15
100.0 %
100.0 %
42
2.3 (8.1)
37
2 (7.4)
16.0 %
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
31.9 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
10.6 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
41.6 %
100.0 %
100.0 %
100.0 %
265
234
44
44
0.59 (1.75)
45
1.47 (1.75)
45
-4
-2
Favours education
Favours control
80
Analysis 2.13. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 13 ED
Visit (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Mitchell 1986
26/133
10/126
27.6 %
Persaud 1996
4/18
9/18
23.4 %
36/63
31/51
49.0 %
214
195
100.0 %
M-H,Fixed,95% CI
1 Mos 1-6
Toelle 1993
13/44
11/45
28.0 %
Madge 1997
7/96
7/105
22.6 %
Shields 1990
24/101
18/104
49.4 %
241
254
100.0 %
8/44
16/45
100.0 %
44
45
100.0 %
0.01
0.1
Favours education
10
100
Favours control
81
Analysis 2.14. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 14 ED
Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
17.2 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
24.7 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
58.1 %
100.0 %
1 Mos 1-6
106
94
11
0.6 (0.9)
10
2.4 (2.1)
2.1 %
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
4.5 %
159
1.72 (4.2)
73
2.49 (6.26)
23.2 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
2.8 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
10.3 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
8.0 %
1.9 (4.72)
7.4 (4.72)
1.4 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
23.9 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
23.8 %
100.0 %
100.0 %
100.0 %
Clark 1986
McNabb 1985
524
390
44
44
0.27 (2.16)
45
0.58 (2.16)
45
-4
-2
Favours education
Favours control
82
Analysis 2.15. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
55/178
45/190
100.0 %
178
190
100.0 %
1/11
4/10
11.7 %
Hughes 1991
15/44
9/45
18.1 %
Madge 1997
8/96
26/105
70.2 %
151
160
100.0 %
M-H,Fixed,95% CI
1 Mos 1-6
Mitchell 1986
6/44
6/45
14.8 %
Mitchell 1986
57/178
45/190
85.2 %
222
235
100.0 %
0.01
0.1
Favours education
10
100
Favours control
83
Analysis 2.16. Comparison 2 Self-Management vs. Usual Care by Time Since Enrollment, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
88.0 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
12.0 %
100.0 %
1 Mos 1-6
203
215
11
0.09 (0.3)
10
0.6 (0.84)
4.2 %
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
8.4 %
175
0.11 (0.43)
81
0.21 (0.85)
48.0 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
5.2 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
19.3 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
15.0 %
100.0 %
Clark 1986
318
192
44
0.18 (0.14)
45
0.16 (0.14)
19.5 %
Mitchell 1986
178
0.75 (2.13)
190
0.39 (1.28)
80.5 %
100.0 %
222
235
-4
-2
Favours education
Favours control
84
Analysis 3.1. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 1
Lung Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Carswell 1989
43
109 (19)
43
100 (19)
34.3 %
Christiansen 1997
27
331.37 (53.52)
15
313.53 (40.63)
15.6 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
43.6 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
6.6 %
-4
-2
Favours control
Favours education
85
Analysis 3.2. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 2
Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
86
Analysis 3.3. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
58.8 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
8.4 %
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
18.7 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
14.2 %
100.0 %
100.0 %
100.0 %
1 Symptom-based Strategies
150
125
32
2.56 (2.06)
31
32
3.1 (2.06)
31
-4
-2
Favours educaton
Favours control
Analysis 3.4. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 4
School Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
Favours education
10
100
Favours control
87
Analysis 3.5. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 5
School Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.1 (11.4)
37
4.7 (15.5)
15.9 %
Christiansen 1997
27
2.39 (2.9)
15
2.98 (3.29)
7.8 %
0.8 (0.32)
10
0.9 (0.32)
3.8 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
12.7 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
17.7 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
7.3 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
22.9 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
11.9 %
100.0 %
Dahl 1990
265
236
45
0.98 (1.56)
34
0.53 (1.08)
6.8 %
117
19.4 (13.9)
87
19.7 (12.6)
17.8 %
13
0.5 (5.06)
13
4.6 (5.06)
2.1 %
Hill 1991
211
5.43 (4.07)
193
6.23 (4.72)
35.9 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
23.1 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
5.0 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
4.7 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
4.4 %
100.0 %
Evans 1987
Fireman 1981
602
530
-1
-0.5
Favours education
0.5
Favours control
88
Analysis 3.6. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 6
Restricted Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
Favours education
10
100
Favours control
89
Analysis 3.7. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 7
Restricted Activity (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
2.27 (4.87)
34
1.79 (3.58)
26.8 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
53.9 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
8.7 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
10.6 %
100.0 %
1 Symptom-based Strategies
167
130
5.9 (1.86)
10
7.7 (1.86)
21.8 %
32
1.41 (1.63)
31
2.42 (1.63)
78.2 %
100.0 %
41
41
-4
-2
Favours education
Favours control
90
Analysis 3.8. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 8
Nights Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 3.9. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 9
Nights Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Deaves 1993
32
2.16 (1.99)
31
3.9 (1.99)
50.1 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
49.9 %
100.0 %
100.0 %
100.0 %
64
59
45
45
1.82 (2.54)
34
1.08 (3.69)
34
-4
-2
Favours education
Favours control
91
Analysis 3.10. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 10
Self-Efficacy Scale.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
18
2.2 (2.3)
18
0.8 (3.5)
Weight
IV,Fixed,95% CI
18
18
100.0 %
100.0 %
48
42.72 (3.47)
30
40.28 (3.99)
22.6 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
32.6 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
16.6 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
16.1 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
12.1 %
100.0 %
174
150
-4
-2
Favours control
Favours education
92
Analysis 3.11. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 11
Asthma Severity Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
23.5 %
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
56.7 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
19.8 %
100.0 %
100.0 %
100.0 %
86
76
25
-49.68 (6.87)
25
25
-45.86 (7.57)
25
-4
-2
Favours education
Favours control
93
Analysis 3.12. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 12
General Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
35.5 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
6.5 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
11.8 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
46.2 %
100.0 %
1 Symptom-based Strategies
239
212
42
2.3 (8.1)
37
2 (7.4)
47.7 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
52.3 %
100.0 %
86
82
-1
-0.5
Favours education
0.5
Favours control
94
Analysis 3.13. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 13
ED Visit (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
21.6 %
Madge 1997
7/96
7/105
17.4 %
Persaud 1996
4/18
9/18
19.7 %
36/63
31/51
41.3 %
221
219
100.0 %
M-H,Fixed,95% CI
Toelle 1993
26/133
10/126
37.9 %
Shields 1990
24/101
18/104
62.1 %
234
230
100.0 %
0.01
0.1
Favours education
10
100
Favours control
95
Analysis 3.14. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 14
ED Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
14.1 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
32.5 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
12.2 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
41.2 %
100.0 %
152
129
11
0.6 (0.9)
10
2.4 (2.1)
2.3 %
159
1.72 (4.2)
73
2.49 (6.26)
25.6 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
3.1 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
8.8 %
1.9 (4.72)
7.4 (4.72)
1.5 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
26.3 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
26.3 %
25
0.44 (0.77)
25
1.08 (1.32)
6.1 %
100.0 %
Clark 1986
McNabb 1985
Talabere 1993
478
355
-4
-2
Favours education
Favours control
96
Analysis 3.15. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
6/44
6/45
18.4 %
Madge 1997
8/96
26/105
81.6 %
140
150
100.0 %
1/11
4/10
11.2 %
55/178
45/190
88.8 %
189
200
100.0 %
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
97
Analysis 3.16. Comparison 3 Self-management vs. Usual Care by Self-management Strategy, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
30.2 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
69.8 %
100.0 %
71
60
11
0.09 (0.3)
10
0.6 (0.84)
2.6 %
175
0.11 (0.43)
81
0.21 (0.85)
29.5 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
3.2 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
9.2 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
48.9 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
6.7 %
100.0 %
Clark 1986
450
347
-1
-0.5
Favours education
0.5
Favours control
98
Analysis 4.1. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 1 Lung
Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
331.37 (53.52)
15
313.53 (40.63)
23.7 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
66.3 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
10.0 %
98
100.0 %
100.0 %
100.0 %
1 Group Interventions
74
43
43
109 (19)
43
100 (19)
43
-4
-2
Favours control
Favours education
99
Analysis 4.2. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 2
Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
1 Group Interventions
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
100
Analysis 4.3. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
80.6 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
19.4 %
100.0 %
100.0 %
100.0 %
1 Group Intervention
112
87
13
1.5 (4.1)
13
13
6 (4.1)
13
32
2.56 (2.06)
31
3.1 (2.06)
55.6 %
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
44.4 %
100.0 %
57
56
-4
-2
Favours education
Favours control
101
Analysis 4.4. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 4 School
Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Group Interventions
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 4.5. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 5 School
Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
42
2.1 (11.4)
37
4.7 (15.5)
12.2 %
0.8 (0.32)
10
0.9 (0.32)
2.9 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
9.7 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
13.5 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
40.3 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
5.6 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
8.3 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
7.6 %
100.0 %
1 Individual Interventions
Charlton 1994
Dahl 1990
332
317
-1
-0.5
Favours education
0.5
Favours control
(Continued . . . )
102
(. . .
Study or subgroup
Education
N
Control
Mean(SD)
Mean(SD)
Weight
IV,Fixed,95% CI
Continued)
27
2.39 (2.9)
15
2.98 (3.29)
4.1 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
8.1 %
Evans 1987
117
19.4 (13.9)
87
19.7 (12.6)
21.2 %
Hill 1991
211
5.43 (4.07)
193
6.23 (4.72)
42.6 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
5.9 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
12.0 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
6.2 %
100.0 %
100.0 %
100.0 %
522
436
13
0.5 (5.06)
13
13
4.6 (5.06)
13
-1
-0.5
Favours education
0.5
Favours control
Analysis 4.6. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 6 Restricted
Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Group Intervention
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
103
Analysis 4.7. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 7 Restricted
Activity (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
2.27 (4.87)
34
1.79 (3.58)
29.3 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
59.0 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
11.6 %
100.0 %
1 Group Interventions
154
117
5.9 (1.86)
10
7.7 (1.86)
21.8 %
32
1.41 (1.63)
31
2.42 (1.63)
78.2 %
100.0 %
100.0 %
100.0 %
Dahl 1990
Deaves 1993
41
41
13
13
3.1 (2.9)
13
4.6 (2.9)
13
-4
-2
Favours education
Favours control
104
Analysis 4.8. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 8 Nights
Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Group Interventions
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 4.9. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 9 Nights
Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
57.4 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
42.6 %
100.0 %
100.0 %
100.0 %
1 Group Interventions
77
62
32
2.16 (1.99)
32
31
3.9 (1.99)
31
-4
-2
Favours education
Favours control
105
Analysis 4.10. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 10 SelfEfficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
48
42.72 (3.47)
30
40.28 (3.99)
33.5 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
48.5 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
18.0 %
100.0 %
1 Group Interventions
120
100
18
2.2 (2.3)
18
0.8 (3.5)
25.6 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
37.8 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
36.6 %
100.0 %
72
68
-1
-0.5
Favours control
0.5
Favours education
106
Analysis 4.11. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 11 Asthma
Severity Scale.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
27
Weight
IV,Fixed,95% CI
1 Group Interventions
15
100.0 %
100.0 %
44
2.23 (0.96)
45
2.04 (0.88)
52.8 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
18.5 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
28.8 %
100.0 %
84
86
-4
-2
Favours education
Favours control
107
Analysis 4.12. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 12 General
Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
84.5 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
15.5 %
100.0 %
1 Group Interventions
109
83
42
2.3 (8.1)
37
2 (7.4)
36.2 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
39.7 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
24.1 %
100.0 %
100.0 %
100.0 %
115
107
101
101
1.63 (2.28)
104
1.86 (4.24)
104
-4
-2
Favours education
Favours control
108
Analysis 4.13. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 13 ED Visit
(% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
36/63
31/51
100.0 %
63
51
100.0 %
Hughes 1991
13/44
11/45
26.3 %
Madge 1997
7/96
7/105
21.3 %
Mitchell 1986
26/133
10/126
28.4 %
Persaud 1996
4/18
9/18
24.0 %
291
294
100.0 %
24/101
18/104
100.0 %
101
104
100.0 %
M-H,Fixed,95% CI
1 Group Interventions
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
109
Analysis 4.14. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 14 ED Visits
(mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
27
0.3 (1.2)
15
0.2 (0.43)
6.2 %
Clark 1986
159
1.72 (4.2)
73
2.49 (6.26)
31.9 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
11.0 %
114
0.07 (0.32)
95
0.23 (0.78)
32.8 %
63
1.51 (2.31)
51
1.67 (2.4)
18.0 %
100.0 %
1 Group Interventions
Christiansen 1997
Ronchetti 1997
Toelle 1993
411
262
11
0.6 (0.9)
10
2.4 (2.1)
8.9 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
44.6 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
5.8 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
16.7 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
24.0 %
100.0 %
105
105
13
0.08 (1.14)
13
1 (1.14)
10.4 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
89.6 %
100.0 %
114
117
-4
-2
Favours education
Favours control
110
Analysis 4.15. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Alexander 1988
1/11
4/10
6.2 %
Hughes 1991
6/44
6/45
8.3 %
Madge 1997
8/96
26/105
36.8 %
55/178
45/190
48.7 %
M-H,Fixed,95% CI
1 Individual Interventions
Mitchell 1986
0.01
0.1
Favours education
10
100
Favours control
111
Analysis 4.16. Comparison 4 Self-management vs. Usual Care by Intervention Type, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
27
0.03 (1.4)
15
0.25 (0.98)
11.7 %
Clark 1986
175
0.11 (0.43)
81
0.21 (0.85)
67.2 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
21.1 %
100.0 %
1 Group Interventions
Christiansen 1997
250
124
11
0.09 (0.3)
10
0.6 (0.84)
3.6 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
16.9 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
69.9 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
9.5 %
100.0 %
100.0 %
100.0 %
258
270
13
13
0 (0.38)
13
0.31 (0.38)
13
-4
-2
Favours education]
Favours control
112
Analysis 5.1. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 1 Lung
Function.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
43
109 (19)
43
100 (19)
Weight
IV,Fixed,95% CI
1 Single Sessions
Carswell 1989
43
43
100.0 %
100.0 %
27
331.37 (53.52)
15
313.53 (40.63)
23.7 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
66.3 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
10.0 %
98
100.0 %
74
-4
-2
Favours control
Favours education
Analysis 5.2. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 2
Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
64/133
57/126
84.0 %
48/60
25/44
16.0 %
M-H,Fixed,95% CI
1 Multiple Sessions
Mitchell 1986
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
113
Analysis 5.3. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
58.8 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
8.4 %
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
18.7 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
14.2 %
100.0 %
100.0 %
100.0 %
1 Multiple Sessions
150
125
32
32
2.56 (2.06)
31
3.1 (2.06)
31
-1
-0.5
Favours education
0.5
Favours control
114
Analysis 5.4. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 4 School
Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Multiple Sessions
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 5.5. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 5 School
Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.1 (11.4)
37
4.7 (15.5)
14.4 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
11.5 %
211
5.43 (4.07)
193
6.23 (4.72)
74.1 %
100.0 %
1 Single Sessions
Hill 1991
285
261
27
2.39 (2.9)
15
2.98 (3.29)
3.6 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
7.2 %
0.8 (0.32)
10
0.9 (0.32)
1.8 %
Dahl 1990
-1
-0.5
Favours education
0.5
Favours control
(Continued . . . )
115
Study or subgroup
Education
Control
Weight
(. . . Continued)
Std. Mean Difference
Mean(SD)
Mean(SD)
117
19.4 (13.9)
87
19.7 (12.6)
18.7 %
Fireman 1981
13
0.5 (5.06)
13
4.6 (5.06)
2.2 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
8.1 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
24.2 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
5.2 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
3.3 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
5.0 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
4.6 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
10.6 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
5.5 %
100.0 %
Evans 1987
582
IV,Fixed,95% CI
IV,Fixed,95% CI
505
-1
-0.5
Favours education
0.5
Favours control
Analysis 5.6. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 6
Restricted Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Multiple Sessions
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
116
Analysis 5.7. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 7
Restricted Activity (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
45
2.27 (4.87)
34
1.79 (3.58)
25.3 %
Dahl 1990
5.9 (1.86)
10
7.7 (1.86)
5.5 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
51.0 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
8.2 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
10.1 %
100.0 %
100.0 %
100.0 %
1 Multiple Sessions
Colland 1993
176
140
32
32
1.41 (1.63)
31
2.42 (1.63)
31
-4
-2
Favours education
Favours control
117
Analysis 5.8. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 8 Nights
Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Multiple Sessions
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 5.9. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 9 Nights
Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
57.4 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
42.6 %
100.0 %
100.0 %
100.0 %
1 Multiple Sessions
77
62
32
2.16 (1.99)
32
31
3.9 (1.99)
31
-4
-2
Favours education
Favours control
118
Analysis 5.10. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 10 SelfEfficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
48
42.72 (3.47)
30
40.28 (3.99)
20.3 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
29.3 %
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
10.1 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
14.9 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
14.5 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
10.9 %
1 Multiple Sessions
-4
-2
Favours control
Favours education
Analysis 5.11. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 11
Asthma Severity Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
17.9 %
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
43.3 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
15.2 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
23.6 %
1 Multiple Sessions
-4
-2
Favours education
Favours control
119
Analysis 5.12. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 12
General Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
29.7 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
5.5 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
16.3 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
9.9 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
38.7 %
100.0 %
100.0 %
100.0 %
1 Multiple Sessions
283
257
42
42
2.3 (8.1)
37
2 (7.4)
37
-4
-2
Favours education
Favours control
120
Analysis 5.13. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 13 ED
Visit (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
13.4 %
Madge 1997
7/96
7/105
10.8 %
Mitchell 1986
26/133
10/126
14.4 %
Persaud 1996
4/18
9/18
12.2 %
Shields 1990
24/101
18/104
23.6 %
Toelle 1993
36/63
31/51
25.6 %
M-H,Fixed,95% CI
1 Multiple Sessions
0.01
0.1
Favours education
10
100
Favours control
121
Analysis 5.14. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 14 ED
Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Alexander 1988
11
0.6 (0.9)
10
2.4 (2.1)
1.7 %
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
3.7 %
159
1.72 (4.2)
73
2.49 (6.26)
19.0 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
2.3 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
8.4 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
6.5 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
1.1 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
3.2 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
19.5 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
19.4 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
4.5 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
10.7 %
1 Multiple Sessions
Clark 1986
-4
-2
Favours education
Favours control
122
Analysis 5.15. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Alexander 1988
1/11
4/10
6.2 %
Hughes 1991
6/44
6/45
8.3 %
Madge 1997
8/96
26/105
36.8 %
55/178
45/190
48.7 %
M-H,Fixed,95% CI
1 Multiple sessions
Mitchell 1986
0.01
0.1
Favours education
10
100
Favours control
123
Analysis 5.16. Comparison 5 Self-management vs. Usual Care by Intervention Intensity, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Alexander 1988
11
0.09 (0.3)
10
0.6 (0.84)
2.2 %
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
4.4 %
175
0.11 (0.43)
81
0.21 (0.85)
25.2 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
2.7 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
10.1 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
7.9 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
41.8 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
5.7 %
1 Multiple Sessions
Clark 1986
-1
-0.5
Favours education
0.5
Favours control
124
Analysis 6.1. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 1 Lung Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Carswell 1989
43
109 (19)
43
100 (19)
83.9 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
16.1 %
54
100.0 %
1 RCT
52
27
331.37 (53.52)
15
313.53 (40.63)
26.3 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
73.7 %
100.0 %
87
65
-4
-2
Favours control
Favours education
125
Analysis 6.2. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 2 Exacerbation (%
patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
1 CCT
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
126
Analysis 6.3. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 3 Exacerbations
(Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
64.1 %
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
20.4 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
15.5 %
100.0 %
1 RCT
137
112
32
2.56 (2.06)
31
3.1 (2.06)
73.7 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
26.3 %
100.0 %
45
44
-4
-2
Favours education
Favours control
Analysis 6.4. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 4 School Absences (%
patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 CCT
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
127
Analysis 6.5. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 5 School Absences
(mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.1 (11.4)
37
4.7 (15.5)
5.7 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
5.6 %
0.8 (0.32)
10
0.9 (0.32)
1.4 %
Evans 1987
117
19.4 (13.9)
87
19.7 (12.6)
14.5 %
Hill 1991
211
5.43 (4.07)
193
6.23 (4.72)
29.3 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
6.3 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
18.9 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
4.1 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
2.6 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
3.9 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
3.6 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
4.3 %
100.0 %
1 RCT
Dahl 1990
732
656
27
2.39 (2.9)
15
2.98 (3.29)
16.2 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
26.2 %
Fireman 1981
13
0.5 (5.06)
13
4.6 (5.06)
10.1 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
47.5 %
100.0 %
135
110
-1
-0.5
Favours education
0.5
Favours control
128
Analysis 6.6. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 6 Restricted Activity
(% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 CCT
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
129
Analysis 6.7. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 7 Restricted Activity
(mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
45
2.27 (4.87)
34
1.79 (3.58)
27.6 %
Dahl 1990
5.9 (1.86)
10
7.7 (1.86)
6.0 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
55.5 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
11.0 %
100.0 %
1 RCT
Colland 1993
163
127
32
1.41 (1.63)
31
2.42 (1.63)
70.5 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
29.5 %
100.0 %
45
44
-4
-2
Favours education
Favours control
130
Analysis 6.8. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 8 Nights Nocturnal
Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 CCT
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 6.9. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 9 Nights Nocturnal
Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
57.4 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
42.6 %
100.0 %
100.0 %
100.0 %
1 RCT
77
62
32
2.16 (1.99)
32
31
3.9 (1.99)
31
-4
-2
Favours education
Favours control
131
Analysis 6.10. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 10 Self-Efficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
48
42.72 (3.47)
30
40.28 (3.99)
28.7 %
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
14.3 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
21.1 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
20.5 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
15.4 %
100.0 %
100.0 %
100.0 %
1 RCT
139
117
53
53
30.2 (5.91)
51
27.5 (5.91)
51
-4
-2
Favours control
Favours education
132
Analysis 6.11. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 11 Asthma Severity
Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
52.8 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
18.5 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
28.8 %
100.0 %
100.0 %
100.0 %
1 RCT
84
86
27
27
2.87 (2.34)
15
4.36 (2.21)
15
-4
-2
Favours education
Favours control
133
Analysis 6.12. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 12 General
Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.3 (8.1)
37
2 (7.4)
12.9 %
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
25.8 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
4.7 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
14.2 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
8.6 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
33.7 %
1 RCT
-1
-0.5
Favours education
0.5
Favours control
134
Analysis 6.13. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 13 ED Visit (%
patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
18.0 %
Madge 1997
7/96
7/105
14.5 %
Mitchell 1986
26/133
10/126
19.4 %
Persaud 1996
4/18
9/18
16.4 %
24/101
18/104
31.7 %
392
398
100.0 %
36/63
31/51
100.0 %
63
51
100.0 %
M-H,Fixed,95% CI
1 RCT
Shields 1990
0.01
0.1
Favours education
10
100
Favours control
135
Analysis 6.14. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 14 ED Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
11
0.6 (0.9)
10
2.4 (2.1)
2.0 %
159
1.72 (4.2)
73
2.49 (6.26)
22.7 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
10.1 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
7.8 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
1.3 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
3.8 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
23.4 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
23.3 %
25
0.44 (0.77)
25
1.08 (1.32)
5.4 %
100.0 %
1 RCT
Alexander 1988
Clark 1986
Talabere 1993
527
405
27
0.3 (1.2)
15
0.2 (0.43)
22.0 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
13.6 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
64.4 %
100.0 %
103
79
-4
-2
Favours education
Favours control
136
Analysis 6.15. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 15 Hospitalization (%
patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Alexander 1988
1/11
4/10
6.2 %
Hughes 1991
6/44
6/45
8.3 %
Madge 1997
8/96
26/105
36.8 %
55/178
45/190
48.7 %
M-H,Fixed,95% CI
1 RCT
Mitchell 1986
0.01
0.1
Favours education
10
100
Favours control
137
Analysis 6.16. Comparison 6 Self-management vs. Usual Care by Trial Type, Outcome 16 Hospitalizations
(mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
11
0.09 (0.3)
10
0.6 (0.84)
2.3 %
175
0.11 (0.43)
81
0.21 (0.85)
27.1 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
10.9 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
8.5 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
45.0 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
6.1 %
100.0 %
1 RCT
Alexander 1988
Clark 1986
481
379
27
0.03 (1.4)
15
0.25 (0.98)
61.7 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
38.3 %
100.0 %
40
28
-1
-0.5
Favours education
0.5
Favours control
138
Analysis 7.1. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 1 Lung Function.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
109 (19)
43
100 (19)
Weight
IV,Fixed,95% CI
43
43
43
100.0 %
100.0 %
27
331.37 (53.52)
15
313.53 (40.63)
26.3 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
73.7 %
100.0 %
100.0 %
100.0 %
87
65
11
11
276.6 (33.86)
232.8 (33.86)
-4
-2
Favours control
Favours education
139
Analysis 7.2. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 2 Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
140
Analysis 7.3. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 3 Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
9 (14.7)
68
11.8 (16.5)
Weight
IV,Fixed,95% CI
93
93
68
100.0 %
100.0 %
25
6.68 (18.67)
25
10.04 (17.13)
56.9 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
43.1 %
100.0 %
44
44
32
2.56 (2.06)
31
3.1 (2.06)
73.7 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
26.3 %
100.0 %
45
44
-4
-2
Favours education
Favours control
141
Analysis 7.4. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 4 School Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 7.5. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 5 School Absences (mean days).
Review:
Study or subgroup
Education
N
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
42
2.1 (11.4)
37
4.7 (15.5)
15.3 %
117
19.4 (13.9)
87
19.7 (12.6)
39.0 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
16.9 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
7.0 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
10.4 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
11.4 %
100.0 %
280
241
-1
-0.5
Favours education
0.5
Favours control
(Continued . . . )
142
(. . .
Study or subgroup
Education
Control
Continued)
Weight
Mean(SD)
Mean(SD)
45
0.98 (1.56)
34
0.53 (1.08)
8.9 %
0.8 (0.32)
10
0.9 (0.32)
2.2 %
Hill 1991
211
5.43 (4.07)
193
6.23 (4.72)
46.7 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
30.1 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
6.5 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
5.7 %
100.0 %
Colland 1993
Dahl 1990
452
IV,Fixed,95% CI
IV,Fixed,95% CI
415
27
2.39 (2.9)
15
2.98 (3.29)
16.2 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
26.2 %
Fireman 1981
13
0.5 (5.06)
13
4.6 (5.06)
10.1 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
47.5 %
100.0 %
135
110
-1
-0.5
Favours education
0.5
Favours control
Analysis 7.6. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 6 Restricted Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
Favours education
10
100
Favours control
143
Analysis 7.7. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 7 Restricted Activity (mean days).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
18.1 (33.5)
68
30.3 (58.3)
Weight
IV,Fixed,95% CI
93
93
68
100.0 %
100.0 %
45
2.27 (4.87)
34
1.79 (3.58)
62.0 %
5.9 (1.86)
10
7.7 (1.86)
13.4 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
24.6 %
70
100.0 %
Dahl 1990
59
32
1.41 (1.63)
31
2.42 (1.63)
70.5 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
29.5 %
100.0 %
45
44
-4
-2
Favours education
Favours control
144
Analysis 7.8. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 8 Nights Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 7.9. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 9 Nights Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
N
Control
Mean(SD)
Mean(SD)
1.3 (1.7)
28
2.6 (2.65)
Weight
IV,Fixed,95% CI
32
32
28
100.0 %
100.0 %
100.0 %
100.0 %
100.0 %
100.0 %
45
1.82 (2.54)
45
34
1.08 (3.69)
34
32
32
2.16 (1.99)
31
3.9 (1.99)
31
-4
-2
Favours education
Favours control
(Continued . . . )
145
(. . .
Study or subgroup
Education
Control
Mean(SD)
Weight
IV,Fixed,95% CI
Continued)
-4
-2
Favours education
Favours control
Analysis 7.10. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 10 Self-Efficacy Scale.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
Weight
IV,Fixed,95% CI
18
2.2 (2.3)
18
0.8 (3.5)
40.4 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
59.6 %
100.0 %
47
43
48
42.72 (3.47)
30
40.28 (3.99)
44.4 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
31.7 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
23.9 %
100.0 %
100.0 %
100.0 %
92
74
53
53
30.2 (5.91)
51
27.5 (5.91)
51
-4
-2
Favours control
Favours education
146
Analysis 7.11. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 11 Asthma Severity Scale.
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
2.23 (0.96)
45
2.04 (0.88)
Weight
IV,Fixed,95% CI
44
44
45
100.0 %
100.0 %
15
-8.87 (1.64)
16
-8.81 (2.46)
39.1 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
60.9 %
100.0 %
100.0 %
100.0 %
40
41
27
27
2.87 (2.34)
15
4.36 (2.21)
15
-4
-2
Favours education
Favours control
147
Analysis 7.12. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 12 General Practitioner visits (mean).
Review:
Study or subgroup
Education
N
Control
Mean(SD)
Mean(SD)
Weight
IV,Fixed,95% CI
42
2.3 (8.1)
37
2 (7.4)
13.6 %
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
27.1 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
14.9 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
9.0 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
35.4 %
100.0 %
100.0 %
100.0 %
309
279
16
16
3 (6.63)
15
7.87 (6.63)
15
-4
-2
Favours education
Favours control
148
Analysis 7.13. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 13 ED Visit (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
22.3 %
Madge 1997
7/96
7/105
18.0 %
Persaud 1996
4/18
9/18
20.4 %
24/101
18/104
39.3 %
259
272
100.0 %
26/133
10/126
100.0 %
133
126
100.0 %
36/63
31/51
100.0 %
63
51
100.0 %
M-H,Fixed,95% CI
Shields 1990
0.01
0.1
Favours education
10
100
Favours control
149
Analysis 7.14. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 14 ED Visits (mean).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
Weight
IV,Fixed,95% CI
44
0.45 (1.05)
45
0.6 (1.05)
21.8 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
16.9 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
2.8 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
8.2 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
50.3 %
100.0 %
218
202
0.6 (0.9)
10
2.4 (2.1)
3.8 %
Clark 1986
159
1.72 (4.2)
73
2.49 (6.26)
42.4 %
Ronchetti 1997
114
0.07 (0.32)
95
0.23 (0.78)
43.6 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
10.2 %
100.0 %
Alexander 1988
309
203
27
0.3 (1.2)
15
0.2 (0.43)
22.0 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
13.6 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
64.4 %
100.0 %
103
79
-1
-0.5
Favours education
0.5
Favours control
150
Analysis 7.15. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 15 Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
6/44
6/45
18.4 %
Madge 1997
8/96
26/105
81.6 %
140
150
100.0 %
1/11
4/10
11.2 %
55/178
45/190
88.8 %
189
200
100.0 %
M-H,Fixed,95% CI
0.01
0.1
Favours education
10
100
Favours control
151
Analysis 7.16. Comparison 7 Self-management vs. Usual Care by Adequacy of Allocation Concealment,
Outcome 16 Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
11
0.09 (0.3)
10
0.6 (0.84)
2.9 %
Clark 1986
175
0.11 (0.43)
81
0.21 (0.85)
33.6 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
55.8 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
7.6 %
100.0 %
389
306
27
0.03 (1.4)
15
0.25 (0.98)
61.7 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
38.3 %
100.0 %
40
28
44
0.45 (0.77)
45
0.56 (0.77)
56.2 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
43.8 %
100.0 %
92
73
-1
-0.5
Favours education
0.5
Favours control
152
Analysis 8.1. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 1 Lung
Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Carswell 1989
43
109 (19)
43
100 (19)
34.3 %
Christiansen 1997
27
331.37 (53.52)
15
313.53 (40.63)
15.6 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
43.6 %
Weingarten 1985
11
276.6 (33.86)
232.8 (33.86)
6.6 %
1 Adequate Follow-up
-4
-2
Favours control
Favours education
153
Analysis 8.2. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 2
Exacerbation (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
1 Adequate Follow-up
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
154
Analysis 8.3. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Deaves 1993
32
2.56 (2.06)
31
3.1 (2.06)
19.0 %
Evans 1987
93
9 (14.7)
68
11.8 (16.5)
47.6 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
6.8 %
Talabere 1993
25
6.68 (18.67)
25
10.04 (17.13)
15.1 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
11.5 %
1 Adequate Follow-up
-1
-0.5
Favours education
0.5
Favours control
Analysis 8.4. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 4 School
Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Adequate Follow-up
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
155
Analysis 8.5. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 5 School
Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.1 (11.4)
37
4.7 (15.5)
8.8 %
Christiansen 1997
27
2.39 (2.9)
15
2.98 (3.29)
4.3 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
8.6 %
0.8 (0.32)
10
0.9 (0.32)
2.1 %
32
3.69 (4.8)
31
5.19 (4.8)
7.0 %
117
19.4 (13.9)
87
19.7 (12.6)
22.3 %
Fireman 1981
13
0.5 (5.06)
13
4.6 (5.06)
2.7 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
9.7 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
4.0 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
5.9 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
5.5 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
12.6 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
6.6 %
100.0 %
1 Adequate Follow-up
Dahl 1990
Deaves 1993
Evans 1987
494
420
211
5.43 (4.07)
193
6.23 (4.72)
56.1 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
36.1 %
29
0.24 (0.9)
27
0.22 (1)
7.8 %
100.0 %
Perrin 1992
373
346
-1
-0.5
Favours education
0.5
Favours control
156
Analysis 8.6. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 6
Restricted Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Adequate Follow-up
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 8.7. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 7
Restricted Activity (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
45
2.27 (4.87)
34
1.79 (3.58)
23.1 %
5.9 (1.86)
10
7.7 (1.86)
5.0 %
Deaves 1993
32
1.41 (1.63)
31
2.42 (1.63)
17.9 %
Evans 1987
93
18.1 (33.5)
68
30.3 (58.3)
46.5 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
7.5 %
100.0 %
100.0 %
1 Adequate Follow-up
Colland 1993
Dahl 1990
192
156
16
37.31 (57.6)
15
51.47 (57.6)
-4
-2
Favours education
Favours control
(Continued . . . )
157
Study or subgroup
Education
N
Control
Mean(SD)
16
Weight
IV,Fixed,95% CI
(. . . Continued)
Std. Mean Difference
IV,Fixed,95% CI
15
100.0 %
-4
-2
Favours education
Favours control
Analysis 8.8. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 8 Nights
Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Adequate Follow-up
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
158
Analysis 8.9. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 9 Nights
Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
45
1.82 (2.54)
34
1.08 (3.69)
40.2 %
Deaves 1993
32
2.16 (1.99)
31
3.9 (1.99)
29.9 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
29.9 %
1 Adequate Follow-up
-4
-2
Favours education
Favours control
Analysis 8.10. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 10 SelfEfficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Colland 1993
48
42.72 (3.47)
30
40.28 (3.99)
23.8 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
34.5 %
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
11.9 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
17.0 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
12.8 %
100.0 %
1 Adequate Follow-up
163
143
-4
-2
Favours control
Favours education
(Continued . . . )
159
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
29
33.5 (3.8)
25
31.4 (3.8)
Weight
IV,Fixed,95% CI
(. . . Continued)
Std. Mean Difference
IV,Fixed,95% CI
2 Inadequate Follow-up
Rubin 1986
29
25
100.0 %
100.0 %
-4
-2
Favours control
Favours education
Analysis 8.11. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 11
Asthma Severity Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
17.9 %
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
43.3 %
LeBaron 1985
15
-8.87 (1.64)
16
-8.81 (2.46)
15.2 %
Talabere 1993
25
-49.68 (6.87)
25
-45.86 (7.57)
23.6 %
1 Adequate Follow-up
-4
-2
Favours education
Favours control
160
Analysis 8.12. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 12
General Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Charlton 1994
42
2.3 (8.1)
37
2 (7.4)
14.9 %
Evans 1987
93
3.6 (6.2)
68
3.3 (3.8)
29.8 %
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
16.4 %
Shields 1990
101
1.63 (2.28)
104
1.86 (4.24)
38.9 %
100.0 %
1 Adequate Follow-up
280
254
16
3 (6.63)
15
7.87 (6.63)
35.6 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
64.4 %
100.0 %
45
40
-4
-2
Favours education
Favours control
161
Analysis 8.13. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 13 ED
Visit (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
15.6 %
Madge 1997
7/96
7/105
12.6 %
Persaud 1996
4/18
9/18
14.3 %
Shields 1990
24/101
18/104
27.6 %
Toelle 1993
36/63
31/51
29.9 %
322
323
100.0 %
26/133
10/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
1 Adequate Follow-up
0.01
0.1
Favours education
10
100
Favours control
162
Analysis 8.14. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 14 ED
Visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Alexander 1988
11
0.6 (0.9)
10
2.4 (2.1)
2.1 %
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
4.5 %
159
1.72 (4.2)
73
2.49 (6.26)
23.6 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
2.8 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
10.5 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
8.1 %
McNabb 1985
1.9 (4.72)
7.4 (4.72)
1.4 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
3.9 %
Shields 1990
101
0.54 (1.68)
104
0.38 (1.68)
24.2 %
Talabere 1993
25
0.44 (0.77)
25
1.08 (1.32)
5.6 %
Toelle 1993
63
1.51 (2.31)
51
1.67 (2.4)
13.3 %
100.0 %
100.0 %
100.0 %
1 Adequate Follow-up
Clark 1986
516
389
114
114
0.07 (0.32)
95
0.23 (0.78)
95
-1
-0.5
Favours education
0.5
Favours control
163
Analysis 8.15. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Alexander 1988
1/11
4/10
12.0 %
Hughes 1991
6/44
6/45
16.2 %
Madge 1997
8/96
26/105
71.8 %
151
160
100.0 %
55/178
45/190
100.0 %
178
190
100.0 %
M-H,Fixed,95% CI
1 Adequate Follow-up
0.01
0.1
Favours education
10
100
Favours control
164
Analysis 8.16. Comparison 8 Self-management vs. Usual Care by Adequacy of Follow-up, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Alexander 1988
11
0.09 (0.3)
10
0.6 (0.84)
3.7 %
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
7.5 %
175
0.11 (0.43)
81
0.21 (0.85)
43.3 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
4.7 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
17.4 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
13.6 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
9.8 %
100.0 %
100.0 %
100.0 %
1 Adequate Follow-up
Clark 1986
343
217
178
178
0.5 (1.28)
190
0.33 (0.96)
190
-1
-0.5
Favours education
0.5
Favours control
165
Analysis 9.1. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 1 Lung
Function.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Carswell 1989
43
109 (19)
43
100 (19)
44.1 %
Toelle 1993
60
2.13 (0.51)
50
1.9 (0.47)
55.9 %
100.0 %
100.0 %
100.0 %
100.0 %
100.0 %
1 Mild-moderate Asthma
103
93
27
27
331.37 (53.52)
15
313.53 (40.63)
15
11
11
276.6 (33.86)
232.8 (33.86)
-4
-2
Favours control
Favours education
166
Analysis 9.2. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 2 Exacerbation
(% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
48/60
25/44
100.0 %
60
44
100.0 %
64/133
57/126
100.0 %
133
126
100.0 %
M-H,Fixed,95% CI
1 Mild-Moderate Asthma
Toelle 1993
0.01
0.1
Favours education
10
100
Favours control
167
Analysis 9.3. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 3
Exacerbations (Mean).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
93
9 (14.7)
68
11.8 (16.5)
Weight
IV,Fixed,95% CI
1 Mild-Moderate Asthma
Evans 1987
93
68
100.0 %
100.0 %
32
2.56 (2.06)
31
3.1 (2.06)
51.0 %
Fireman 1981
13
1.5 (4.1)
13
6 (4.1)
18.2 %
Whitman 1985
19
6.26 (8.08)
19
4.47 (8.08)
30.8 %
100.0 %
100.0 %
100.0 %
64
63
25
25
6.68 (18.67)
25
10.04 (17.13)
25
-1
-0.5
Favours education
0.5
Favours control
168
Analysis 9.4. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 4 School
Absences (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
37/63
33/51
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mild-Moderate Asthma
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 9.5. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 5 School
Absences (mean days).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Evans 1987
117
19.4 (13.9)
87
19.7 (12.6)
63.9 %
Toelle 1993
63
2.62 (3.28)
51
2.67 (3.21)
36.1 %
100.0 %
1 Mild-Moderate Asthma
180
138
2.39 (2.9)
15
2.98 (3.29)
4.6 %
0.8 (0.32)
10
0.9 (0.32)
2.2 %
Deaves 1993
32
3.69 (4.8)
31
5.19 (4.8)
7.5 %
Fireman 1981
13
0.5 (5.06)
13
4.6 (5.06)
2.9 %
Christiansen 1997
Dahl 1990
-1
-0.5
Favours education
0.5
Favours control
(Continued . . . )
169
(. . .
Study or subgroup
Education
Control
Continued)
Weight
Mean(SD)
Mean(SD)
211
5.43 (4.07)
193
6.23 (4.72)
48.1 %
Hughes 1991
44
10.7 (6.9)
45
16 (15.4)
10.4 %
Perrin 1992
29
0.24 (0.9)
27
0.22 (1)
6.7 %
Persaud 1996
18
6.4 (4.6)
18
7.6 (5.3)
4.3 %
Rubin 1986
29
11.9 (7.8)
25
15.4 (15)
6.4 %
Wilson 1996
30
0.8 (2.29)
29
1.4 (3.23)
7.0 %
100.0 %
Hill 1991
442
IV,Fixed,95% CI
IV,Fixed,95% CI
406
42
2.1 (11.4)
37
4.7 (15.5)
16.9 %
Colland 1993
45
0.98 (1.56)
34
0.53 (1.08)
16.5 %
Mitchell 1986
133
7.92 (16.48)
126
8.48 (26.69)
55.9 %
Talabere 1993
25
1.36 (2.52)
25
2.6 (3.75)
10.6 %
100.0 %
245
222
-1
-0.5
Favours education
0.5
Favours control
Analysis 9.6. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 6 Restricted
Activity (% patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
8/43
3/36
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mild-Moderate Asthma
Toelle 1993
100.0 %
0.01
0.1
Favours education
10
100
Favours control
170
Analysis 9.7. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 7 Restricted
Activity (mean days).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
93
18.1 (33.5)
68
30.3 (58.3)
Weight
IV,Fixed,95% CI
1 Mild-Moderate Severity
Evans 1987
93
68
100.0 %
100.0 %
45
2.27 (4.87)
34
1.79 (3.58)
71.6 %
Holzheimer 1998
16
37.31 (57.6)
15
51.47 (57.6)
28.4 %
61
100.0 %
49
5.9 (1.86)
10
7.7 (1.86)
16.4 %
Deaves 1993
32
1.41 (1.63)
31
2.42 (1.63)
58.9 %
Fireman 1981
13
3.1 (2.9)
13
4.6 (2.9)
24.6 %
100.0 %
54
54
-4
-2
Favours education
Favours control
171
Analysis 9.8. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 8 Nights
Nocturnal Asthma (% Patients).
Review:
Study or subgroup
Education
Control
n/N
n/N
22/59
21/44
Odds Ratio
Weight
M-H,Fixed,95% CI
Odds Ratio
M-H,Fixed,95% CI
1 Mild-Moderate Severity
Toelle 1993
100.0 %
0.01
0.1
10
Favours education
100
Favours control
Analysis 9.9. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 9 Nights
Nocturnal Asthma (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Deaves 1993
32
2.16 (1.99)
31
3.9 (1.99)
50.1 %
Wilson 1996
32
1.3 (1.7)
28
2.6 (2.65)
49.9 %
100.0 %
100.0 %
100.0 %
1 Moderate-Severe Severity
64
59
45
45
1.82 (2.54)
34
1.08 (3.69)
34
-4
-2
Favours education
Favours control
172
Analysis 9.10. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 10 SelfEfficacy Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Persaud 1996
18
2.2 (2.3)
18
0.8 (3.5)
28.1 %
Rubin 1986
29
33.5 (3.8)
25
31.4 (3.8)
41.6 %
Whitman 1985
19
34.47 (4.02)
19
35.58 (4.02)
30.3 %
100.0 %
1 Moderate-Severe Severity
66
62
48
42.72 (3.47)
30
40.28 (3.99)
31.7 %
Parcel 1980
53
30.2 (5.91)
51
27.5 (5.91)
45.7 %
Talabere 1993
25
79.94 (10.21)
25
80 (9.43)
22.6 %
100.0 %
126
106
-4
-2
Favours control
Favours education
173
Analysis 9.11. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 11 Asthma
Severity Scale.
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Christiansen 1997
27
2.87 (2.34)
15
4.36 (2.21)
29.3 %
Hughes 1991
44
2.23 (0.96)
45
2.04 (0.88)
70.7 %
100.0 %
100.0 %
100.0 %
100.0 %
100.0 %
1 Moderate-Severe Severity
71
60
15
-8.87 (1.64)
15
16
-8.81 (2.46)
16
25
-49.68 (6.87)
25
25
-45.86 (7.57)
25
-4
-2
Favours education
Favours control
174
Analysis 9.12. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 12 General
Practitioner visits (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Hughes 1991
44
0.59 (1.75)
45
1.47 (1.75)
62.3 %
Rubin 1986
29
2.8 (4.3)
25
4.5 (2.7)
37.7 %
100.0 %
100.0 %
100.0 %
1 Moderate-Severe Severity
73
70
93
3.6 (6.2)
93
68
3.3 (3.8)
68
42
2.3 (8.1)
37
2 (7.4)
25.2 %
Holzheimer 1998
16
3 (6.63)
15
7.87 (6.63)
9.2 %
101
1.63 (2.28)
104
1.86 (4.24)
65.6 %
100.0 %
Shields 1990
159
156
-1
-0.5
Favours education
0.5
Favours control
175
Analysis 9.13. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 13 ED Visit (%
patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Hughes 1991
13/44
11/45
52.3 %
Persaud 1996
4/18
9/18
47.7 %
62
63
100.0 %
36/63
31/51
100.0 %
63
51
100.0 %
7/96
7/105
22.2 %
Mitchell 1986
26/133
10/126
29.5 %
Shields 1990
24/101
18/104
48.3 %
330
335
100.0 %
M-H,Fixed,95% CI
1 Moderate-Severe Severity
0.01
0.1
Favours education
10
100
Favours control
176
Analysis 9.14. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 14 ED Visits
(mean).
Review:
Study or subgroup
Education
Control
Mean(SD)
Mean(SD)
63
1.51 (2.31)
51
1.67 (2.4)
Weight
IV,Fixed,95% CI
1 Mild-Moderate Severity
Toelle 1993
63
51
100.0 %
100.0 %
11
0.6 (0.9)
10
2.4 (2.1)
3.7 %
Christiansen 1997
27
0.3 (1.2)
15
0.2 (0.43)
8.1 %
Fireman 1981
13
0.08 (1.14)
13
1 (1.14)
5.0 %
Hughes 1991
44
0.45 (1.05)
45
0.6 (1.05)
18.6 %
Lewis 1984
48
2.3 (2.98)
28
3.71 (2.98)
14.5 %
Persaud 1996
18
0.27 (0.57)
18
1 (1.2)
7.0 %
114
0.07 (0.32)
95
0.23 (0.78)
43.1 %
100.0 %
Ronchetti 1997
275
224
159
1.72 (4.2)
73
2.49 (6.26)
43.0 %
1.9 (4.72)
7.4 (4.72)
2.5 %
101
0.54 (1.68)
104
0.38 (1.68)
44.1 %
25
0.44 (0.77)
25
1.08 (1.32)
10.3 %
100.0 %
292
209
-1
-0.5
Favours education
0.5
Favours control
177
Analysis 9.15. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 15
Hospitalization (% patients).
Review:
Study or subgroup
Education
Control
Odds Ratio
n/N
n/N
M-H,Fixed,95% CI
Weight
Odds Ratio
Alexander 1988
1/11
4/10
42.6 %
Hughes 1991
6/44
6/45
57.4 %
55
55
100.0 %
8/96
26/105
43.1 %
55/178
45/190
56.9 %
274
295
100.0 %
M-H,Fixed,95% CI
1 Moderate-Severe Severity
0.01
0.1
Favours education
10
100
Favours control
178
Analysis 9.16. Comparison 9 Self-management vs. Usual Care by Asthma Severity, Outcome 16
Hospitalizations (mean).
Review:
Study or subgroup
Education
Control
Weight
IV,Fixed,95% CI
Mean(SD)
Mean(SD)
IV,Fixed,95% CI
Alexander 1988
11
0.09 (0.3)
10
0.6 (0.84)
8.0 %
Christiansen 1997
27
0.03 (1.4)
15
0.25 (0.98)
16.1 %
Fireman 1981
13
0 (0.38)
13
0.31 (0.38)
10.0 %
Hughes 1991
44
0.45 (0.77)
45
0.56 (0.77)
37.1 %
Lewis 1984
48
0.27 (0.76)
28
0.6 (0.76)
28.9 %
100.0 %
1 Moderate-Severe Severity
143
111
175
0.11 (0.43)
81
0.21 (0.85)
34.6 %
Mitchell 1986
178
0.5 (1.28)
190
0.33 (0.96)
57.5 %
Talabere 1993
25
0.08 (0.28)
25
0.12 (0.33)
7.8 %
100.0 %
378
296
-1
-0.5
Favours education
0.5
Favours control
WHATS NEW
Last assessed as up-to-date: 31 July 2002.
Date
Event
Description
23 July 2008
Amended
179
HISTORY
Protocol first published: Issue 3, 1996
Review first published: Issue 1, 2003
Date
Event
Description
1 August 2002
Substantive amendment
CONTRIBUTIONS OF AUTHORS
Dr. Wolf contributed to the original design of this systematic review, the selection of studies for eligibility, data coding and analysis,
and the writing and editing of the text. Dr. Guevara contributed to the selection of studies for eligibility and the writing and editing of
the text, coded the studies, and performed the data analyses. Dr. Grum contributed to the original design of this systematic review, the
selection of studies for eligibility, and the writing and editing of the text. Dr. Clark contributed to the original design of this systematic
review and the writing and editing of the text. Dr Cates contributed to the data analysis and the methodology of the review.
DECLARATIONS OF INTEREST
None known
SOURCES OF SUPPORT
Internal sources
No sources of support supplied
External sources
Fogerty International Center, National Institutes of Health, Grant number NIH 1 F06 TW02123, USA.
National Heart, Lung, and Blood Institute, Grant number NIH 1 K07 HL 03046, USA.
Garfield Weston Foundation, UK.
INDEX TERMS
Medical Subject Headings (MeSH)
Patient Education as Topic; Self Care; Adolescent; Asthma [physiopathology; therapy]; Controlled Clinical Trials as Topic; Program
Evaluation; Randomized Controlled Trials as Topic
180
181