Self-management teaching programs and morbidity of pediatric asthma: A meta-analysis

doi:10.1016/S0091-6749(95)70150-8

Journal of Allergy and Clinical Immunology

Volume 95, Issue 1, January 1995, Pages 34-41

Presented in part at the Annual Meeting of the Ambulatory Pediatric Association, Washington, D.C. May 6, 1993.

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Abstract

Background: Self-management teaching programs are becoming an important asset in the management of pediatric asthma. Objective: The study was designed to evaluate the impact of self-management teaching programs on the morbidity of pediatric asthma. Methods: The meta-analysis included randomized clinical trials, published between 1970 and 1991, addressing the outcome of morbidity. Studies were retrieved from searches of MEDLINE, American Journal of Nursing International Index, and Dissertation Abstracts Online Database. The quality of studies was assessed with the scale of Chalmers. The pooled effect size was calculated by the method of Hedges. Results: The literature search retrieved 23 randomized clinical trials, but 12 studies had to be excluded. Global score of quality of studies (Chalmers' scale) was fair, 51.6% ± 9.9%. As indicated by the effect size (ES) of the pooled studies, self-management teaching did not reduce school absenteeism (ES: 0.04 ± 0.08), asthma attacks (ES: 0.09 ± 0.14), hospitalizations (ES: 0.06 ± 0.08), hospital days (ES: -0.11 ± 0.08), or emergency visits (0.14 ± 0.09). Conclusion: Self-management teaching programs do not seem to reduce morbidity, and future programs should focus more on intermediate outcomes such as behavior. (J ALLERGY CLIN IMMUNOL 1995;95:34-41.)

Section snippets

Search of studies

A literature search of all studies, in either English or French, published between 1970 and 1991, was performed with the key words asthma, education, and self-management programs. Studies were identified through searches of MEDLINE, Index Medicus, American Journal of Nursing International Index, Dissertation Abstracts Online Database, and the bibliography of retrieved studies. Authors of preliminary or pilot studies were contacted in an attempt to obtain further definitive results.

Inclusion criteria

Only

RESULTS

An initial literature search retrieved 106 references in which 23 studies were identified as clinical trials. A more extensive review excluded 12 studies for the following reasons. Three studies were not randomized,20, 21, 22 three studies evaluated a noninteractive teaching intervention consisting of a self-teaching booklet23, 24 or an audiovisual teaching aid,²⁵ and six studies addressed outcomes not related to morbidity such as compliance,²⁶ knowledge,²⁷ attitudes,28, 29 or a combination of

DISCUSSION

This meta-analysis shows that self-management teaching programs have surprisingly little influence on morbidity outcomes. In the case of each morbidity variable, pooled effect size remained below 0.2, which we have already described as a small effect size.

We must emphasize that the number of clinical trials included in the meta-analysis was limited to 11 studies and that not all of the 11 studies addressed the five morbidity outcomes selected for the overview. Consequently, pooling of the

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^☆: From ^athe Department of Pediatrics, University of Montreal; ^bthe Department of Social and Preventive Medicine, University of Montreal; and ^cHôpital Sainte-Justine, Department of Pediatrics, University of Montreal.

^☆☆: Reprint requests: Anne-Claude Bernard-Bonnin, MD, FRCP(c), Département de Pédiatrie, Hôpital Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, Canada H3T 1C5.

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Self-management teaching programs and morbidity of pediatric asthma: A meta-analysis☆,☆☆,★

Abstract

Section snippets

Search of studies

Inclusion criteria

RESULTS

DISCUSSION

J ALLERGY CLIN IMMUNOL

J ALLERGY CLIN IMMUNOL

J ALLERGY CLIN IMMUNOL

Chest

Chest

Control Clin Trials

Psychom Res

J ALLERGY CLIN IMMUNOL

J Chron Dis

Impact of childhood asthma on health

Pediatrics

School functioning of US children with asthma

Pediatrics

Changing patterns of asthma hospitalization among children: 1979 to 1987

JAMA

Trends in rates of admission to hospital and death from asthma among children and young adults in Canada during the 1980s

Can Med Assoc J

Workshop on asthma self-management: summary of workshop discussion

J ALLERGY CLIN IMMUNOL

Asthma self-management programs: premises, not promises

J Asthma

A critique of 19 self-management programs for childhood asthma. Part I. Development and evaluation of the programs

Ped Asthma Allerg Immunol

A critique of 19 self-management programs for childhood asthma. Part II. Comments regarding the scientific merit of the programs

Pediatr Asthma Allergy Immunol

The potential and limitations of meta-analysis

J Epidemiol Community Health

Why do we need systematic overviews of randomized trials?

Stat Med

Meta-analysis in primary care. Theory and practice

Parametric estimation of effect size from a series of experiments