Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease

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Abstract

Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect only on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxationalone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.

References (91)

  • AL Ries

    Position paper of the American Association of cardiovascular and pulmonary rehabilitation: scientific basis of pulmonary rehabilitation

    J Cardiopulmonary Rehab

    (1990)
  • DL Dudley et al.

    Group psychotherapy in patients with severe diffuse obstructive pulmonary syndrome

    Am Rev Respir Dis

    (1969)
  • DL Dudley et al.

    Psychiatric aspects of patients with chronic obstructive pulmonary disease

    Adv Psychosom Med

    (1985)
  • AG Gift et al.

    Depression in patients with COPD

    Heart Lung

    (1993)
  • R Carter et al.

    Exercise training in patients with chronic obstructive pulmonary disease

    Med. Sci. Sports Exercise

    (1992)
  • GV Glass et al.

    Meta-analysis in social research

    (1981)
  • LV Hedges et al.

    Statistical methods for meta-analysis

    (1985)
  • EC Devine

    Effects of psychoeducational care with adult surgical patients: a theory-probing meta-analysis of intervention studies

  • EC Devine et al.

    A meta-analysis of the effects of psychoeducational care in adults with hypertension

    Nurs Res

    (1995)
  • EC Devine et al.

    Effects of psychoeducational care provided to adults with cancer

    Oncol Nurs Forum

    (1995)
  • K Smith et al.

    Respiratory muscle training in chronic airflow limitation: a meta-analysis

    Am Rev Respir Dis

    (1992)
  • J Cohen

    Statistical power analysis for the behavioral sciences

    (1969)
  • LV Hedges et al.

    Statistical methods in the metaanalysis of research on gender differences

  • DP Agle et al.

    Multidisciplinary treatment of chronic pulmonary insufficiency 1. Psychologic aspects of rehabilitation

    Psychosom Med

    (1973)
  • I Alkalay et al.

    Chronic obstructive pulmonary disease: rehabilitation program with continuation on an outpatient basis

    J Am Geriatr Soc

    (1980)
  • N Ambrosino et al.

    A study of short-term effects of rehabilitative therapy in chronic obstructive pulmonary disease

    Respiration

    (1981)
  • T Ashikaga et al.

    Evaluation of a community-based education program for individuals with chronic obstructive pulmonary disease

    J Rehab

    (1980)
  • CJ Atkins et al.

    Behavioral exercise programs in the management of chronic obstructive pulmonary disease

    J Consult Clin Psychol

    (1984)
  • BL Aubuchon

    The effects of positive mental imagery on hope, coping, anxiety, dyspnea and pulmonary function in persons with chronic obstructive pulmonary disease: tests of a nursing intervention and a theoretical model

    Diss Abstr. Int

    (1990)
  • RL Blake et al.

    A randomized controlled evaluation of psychosocial intervention in adults with chronic lung disease

    Fam Med

    (1990)
  • BJ Bohny

    Effects of a program of progressive relaxation on pulmonary function of patients with chronic obstructive pulmonary disease

    Diss Abstr Int

    (1973)
  • HA Booker

    Exercise training and breathing control in patients with chronic airflow limitation

    Physiotherapy

    (1984)
  • DLP Brown

    The effects of exercise reconditioning on cognitive performance and affective status in patients with chronic obstructive pulmonary disease

    Diss Abstr Int

    (1983)
  • MAM Brown

    An analysis of relaxation therapy as a nursing intervention

  • E Chryssidis et al.

    Compliance with aerosol therapy in chronic obstructive lung disease

    NZ Med J

    (1981)
  • A Cockcroft et al.

    Controlled trial of respiratory health worker visiting patients with chronic respiratory disability

    Br Med J

    (1987)
  • ML Corriveau et al.

    Exercise capacity following pulmonary rehabilitation in the elderly

    Mo Med

    (1989)
  • NJM Cox et al.

    A pulmonary rehabilitation program for patients with asthma and mild chronic obstructive pulmonary diseases (COPD)

    Lung

    (1993)
  • P De Blaquiere et al.

    Use and misuse of metered-dose inhalers by patients with chronic lung disease

    Am Rev Respir Dis

    (1989)
  • PL De Tullio et al.

    Effect of pharmacist counseling on ambulatory patients' use of acrosolized bronchodilators

    Am J Hosp Pharm

    (1987)
  • JA Donham

    A comparison of personal and audiovisual instruction of patients with chronic obstructive pulmonary disease

  • AC Fassett

    Effects of pursed lip breathing and bilateral chest wall augmentation on slowing respiratory rates

  • S Foster et al.

    Pulmonary rehabilitation in COPD patients with elevated PCO2

    Am Rev Respir Dis

    (1988)
  • AG Gift et al.

    Relaxation to reduce dyspnea and anxiety in COPD patients

    Nurs Res

    (1992)
  • KA Griffin

    Effectiveness of the nursing intervention of patient teaching of the metered-dose inhaler

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