The Effectiveness of self-management strategies in the management of anxiety in patients with Chronic Obstructive Pulmonary Disease; a systematic review.

Background

Anxiety is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and is associated with lower health-related quality of life, greater hospital admissions, poorer treatment outcomes and an increased risk of morbidity and mortality. The prevalence of psychological disorders among COPD patients highlights the need for an intervention which directly targets patient anxiety.

Aim

To investigate the effectiveness of self-management strategies in the management of anxiety in patients with COPD.

Methods

Studies were identified by searching the following electronic databases: PubMed/MedLine, PEDro, CINAHL, Embase, Google Scholar, ProQuest and Cochrane from September 2011 to September 2021. Nine studies met the predetermined criteria for inclusion and were analysed using narrative synthesis. All included studies focused on self-management as an intervention to address anxiety. Non-experimental studies were excluded. Studies examining self-management interventions relating to eHealth, mHealth, telehealth and mobile applications were excluded. The Cochrane ROB-2 Tool was used to assess the risk of bias. Data extracted and reported according to PRISMA guidelines.

Results

Nine RCTs, involving 9,638 patients were included in this systematic review. Six RCTs showed a significant improvement in anxiety scores following the self-management intervention. The direction of the treatment effect favoured interventions that included psychological counselling or interventions featuring a multi-component self-management programme. The three studies which showed a clinically significant change in anxiety featured common components; a self-management programme which featured an exercise or physical activity component, an action plan and a psychological component in the form of coping mechanisms or anxiety management. Eight studies were judged to be high risk of bias overall and one study was considered to have ‘some concerns’.

Conclusion

There is evidence to suggest that a multicomponent self-management intervention may effectively reduce anxiety amongst patients with clinically stable COPD. The high risk of bias of included studies suggest there may be scope for future RCT studies to explore this research question using objective outcome measures.