| Cevirme et al., 2020, Turkey [18] |
To evaluate the impact of dyspnea and chronic self-care management outcomes of an education-based intervention program compared to routine care. |
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Knowledge/skills: The education-based intervention program was carried out in three stages only for the intervention group, including training sessions: hospital education, home visits + education, telephone monitoring, and guidance.
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Implemented a 3-month education-based intervention program focusing on education, house visits, and phone follow-ups.
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Significantly improved Basal Dyspnea Index, Pulmonary Function Test, and Self-Care Management Practice-Global scores for the intervention group (P < 0.05).
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No significant differences were observed between groups in the baseline dyspnea index and Pulmonary Function Test (P > 0.05).
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The program resulted in partial improvement in dyspnea and significant enhancement in chronic care management among COPD patients.
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1 |
| Davis et al., 2006, USA [37] |
To determine the effect of the intervention on self-efficacy and the relationship between domain-specific self-efficacy, walking performance, and symptom severity in patients with COPD. |
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Knowledge: dyspnea self-management education and an individualized home exercise program.
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Skills: pursed-lip breathing and diaphragmatic breathing, to be used as strategies to manage shortness of breath; heart rate, dyspnea, and oxygen saturation monitoring during exercise sessions.
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Shortness of breath
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Self-efficacy
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Functionality
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All three intervention groups improved self-efficacy for walking after treatment.
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There was a significant change in self-efficacy for walking over time for the total sample (P < 0.001).
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Significant improvement in self-efficacy for managing shortness of breath over time for the entire sample (P < 0.001).
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The study demonstrated that improving self-efficacy is a key outcome of self-management interventions.
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1 |
| Mark et al., 2011, USA [38] |
To measure the effect of PLB training delivered via Skype on dyspnea, physical activity, health-related quality of life, and self-efficacy |
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Knowledge: educational sessions via Skype. Prior to the sessions, a 1-h, face-to-face baseline session was provided during which participants received an overview of the anatomy and physiology of the lungs, and a PLB introduction.
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Skills: a short (15 min) session where a return demonstration of PLB was practiced.
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Shortness of breath
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Quality of life
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Self-efficacy
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Eleven out of twelve participants in the experimental group completed the required four training sessions via telecommunication software.
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At the end of the four weeks, there was a significant improvement in dyspnea self-management. Participants reported a reduction and better control of symptom exacerbation levels.
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The intervention also promoted an improvement in the quality of life and greater autonomy and independence in activities of daily living.
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1 |
| Lorig et al., 2006, USA [39] |
To determine the effectiveness of an Internet-based CDSMP |
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Status variables (pain, shortness of breath, fatigue, illness intrusiveness, health distress, disability, and self-reported global health);
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Health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians);
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Utilization variables (physician visits, emergency room visits, and nights in hospital);
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Self-efficacy.
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At one year, participants showed significant improvements in health distress, fatigue, pain, and shortness of breath.
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Compared to the original small-group program, online participants had more significant reductions in disability.
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The online program improved stretching and range of motion exercises more effectively, while small-group participants did better in aerobic exercise improvement.
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1 |
| Lorig et al., 1999, USA [40] |
To evaluate the effectiveness of a self-management program for chronic diseases designed to be used with a heterogeneous group of patients with chronic diseases; explore the differential effectiveness of the intervention for individuals with specific diseases and comorbidities. |
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RCT
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952 patients, 40 years or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis.
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Knowledge: exercise; use of cognitive symptom management techniques; nutrition; fatigue and sleep management; use of community resources; use of medications; dealing with the emotions of fear, anger, and depression; communication with others including health professionals; problem-solving; decision-making.
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Shortness of breath
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Health behaviors (exercise, cognitive symptom management)
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Unscheduled physician visits
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Hospitalizations
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Length of hospital stay
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Self-rated health, disability
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Social/role activities
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Significant improvements in health behaviors, such as increased exercise (stretching/strengthening and aerobic) and enhanced cognitive symptom management.
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Improvement in health status indicators: self-rated health, disability, social/role activities limitation, energy/fatigue, and health distress.
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Reduction in hospitalizations and shorter hospital stays for the treatment group vs. the control group.
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Post-program: increased aerobic exercise, better-coping strategies, reduced disability, and health distress, and enhanced social and role activities, decreased physician visits.
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No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being
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1 |
| Lavery et al., 2011, England [41] |
To investigate the efficacy of a disease-specific
Expert Patient Programme (EPP) compared with usual care in patients with bronchiectasis. |
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Knowledge: causes of bronchiectasis, disease process, medical investigations, dealing with symptoms, airway clearance techniques, exacerbations, health promotion, and support available.
Topics included general health education, education on self-management treatment strategies, action planning, and problem-solving. |
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Disease-specific EPP significantly improved self-efficacy compared to usual care: exercising regularly, getting information about the disease, obtaining help from the community, managing the disease in general, doing chores, and managing symptoms.
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Patients reported satisfaction with the intervention and learned new self-management techniques.
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The study suggests short-term improvements in self-efficacy for bronchiectasis patients with disease-specific EPP, prompting the need for larger investigations into its efficacy.
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1 |
| Cameron-Tucker et al., 2014, Australia [42] |
To investigate both the efficacy of the CDSMP itself in COPD and the addition of supervised exercise to the CDSMP on physical capacity
measured by the 6MWD. |
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Knowledge: course
Condition-specific information; symptom management: shortness of breath, breathing exercises; muscle relaxation; endurance exercise (discussion); cognitive symptom management; symptom management: anger, fear, frustration, depression, fatigue, pain; communication skills; advance directives for health care; working with and informing the health care team; medication usage: generic advice; healthy eating; how to set action plans and problem solve -
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Skills: supervised exercise sessions
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Both the intervention group (CDSMP + exercise) and the control group experienced statistically significant increases in the 6MWD, with an average improvement of around 20 m.
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There was no statistically significant difference in the improvement of 6MWD between the two groups.
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The findings suggest that participants with COPD attending a CDSMP can expect a slight increase in their physical capacity, but adding a single supervised exercise session may not provide additional benefits.
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1 |
| Kim & Park, 2020, South Korea [43] |
To evaluate the level of dyspnea and the self-management interventions used to alleviate dyspnea in lung cancer patients with concurrent pneumoconiosis, particularly oxygen therapy and bronchodilator treatment; to determine the factors associated with such self-management and to provide a basis for developing an applicable and safe treatment plan for alleviating dyspnea. |
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Analytical cross- sectional study
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79 lung cancer patients with pneumoconiosis, who received oxygen therapy and inhaled bronchodilators for dyspnea treatment.
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Subjective respiratory distress (frequency, severity, degree of pain, and persistence).
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Activities of daily living (Functional Performance Inventory: personal hygiene, housekeeping, exercise, entertainment, spiritual activities, and social activities).
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Pulmonary function
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53.2% of patients adjusted their oxygen intake, and 70.9% used bronchodilators more than the prescribed dosage for dyspnea relief.
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Adjusting oxygen intake was not significantly associated with patient characteristics.
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Increased bronchodilator use was related to the presence of comorbidities, cardiopulmonary function, subjective respiratory distress, activities of daily living, and the number of prescribed bronchodilators.
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Short-term oxygen supply can improve exercise performance.
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Overuse of inhaled drugs may lead to secondary health problems.
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Long-term use of inhaled bronchodilators and steroids increases the risk of pneumonia complications, hemoptysis, and pregnancy-induced hypertension.
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4 |
| Stenekes et al., 2008, Canada [44] |
To survey the population of cystic fibrosis patients in the Canadian Maritimes to gather self-reported assessment and self-management of pain, dyspnea, and cough information. |
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Analytical cross-sectional study
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123 respondents with cystic fibrosis, ranged in age from 7 to 60 years (mean age 19.9 years).
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Skills: pharmacological (puffer/mask/aerosol, antibiotics, ibuprofen, dornase alfa recombinant, oxygen treatment) and nonpharmacological treatments (rest and catch breath, take deep breaths, exempt from physical activity, positive expiratory pressure/physiotherapy, drink water) were used to manage symptom.
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62% of participants experienced breathlessness in the 30 days before the survey.
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35% reported no breathlessness.
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Among those who experienced breathlessness, the mean severity rating on the Numeric Rating Scale was 4.1 (SD 2.2).
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Pain and dyspnea are more common than suspected and a wide variety of pharmacological and nonpharmacological measures are used to treat symptoms.
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4 |
| Benzo et al., 2016, USA [45] |
To investigate the association between emotional intelligence and two meaningful outcomes in COPD: quality of life and self-management abilities |
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Emotional intelligence significantly linked to self-management abilities in COPD patients (P < 0.001).
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There was a significant association of emotional intelligence with all assessed domains of quality of life (dyspnea, emotion, fatigue, and mastery), but not with age or degree of bronchial obstruction (FEV1%).
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Emotional intelligence, being a learnable skill, may complement existing rehabilitation efforts in COPD management.
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Focusing on emotional intelligence could address the gap in treating emotional components of COPD, which are responsible for decreased quality of life and increased healthcare use.
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4 |
| Moreno et al., 2018, Spain [47] |
To determine the impact of an educational program to improve the management of COPD on the perception of quality of life, exercise capacity, degree of dyspnea, and clinical risk of COPD patients. |
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Knowledge: educational program, group sessions (disease awareness, respiratory physiotherapy exercises for the removal of excess mucus and strengthening the muscles involved in breathing; healthy habits (nutrition, physical exercise, daily physical activity), knowledge of exacerbation, and prevention through vaccination. Tobacco consumption, was addressed by reinforcing positive behavior in the ex-smoker group and offering individualized intervention to consumers.
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Skills: workshop on inhalation technique, to improve their therapeutic adherence (description, advantages of the treatment type, expected effect, number of inhalations, duration, correct administration order, and knowledge of the technique).
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Degree of dyspnea
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Quality of life
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Exercise capacity
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The program included education on pulmonary and respiratory pathophysiology, respiratory physiotherapy exercises, inhalation device usage, chronic disease understanding, and self-care measures for exacerbations.
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Quality of life indicators showed clinically and statistically significant improvements (P < 0.001).
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According to the COPD Clinical Questionnaire, there was a notable improvement in symptoms (P < 0.001).
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The intervention positively affected exercise capacity, evidenced by an increase in the distance walked in the 6MWD test.
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Overall, the program significantly impacted clinical aspects, potentially reducing future exacerbations and enhancing patients’ perceived quality of life.
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3 |
| Lorig et al., 2008, USA [48] |
To evaluate the effectiveness of an online self-management program for residents with long-term conditions. |
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Cohort study
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546 participants, the median age was 45, with arthritis being the most common (31%), followed by lung diseases (25%), mental health conditions (17%), hypertension(15%), type-2 diabetes (9%); and a large number (42%) reported various other diseases.
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Knowledge: design of individualized exercise programs; use of cognitive symptom management, (relaxation, visualization, distraction and self-talk); methods for managing negative emotions (anger, fear and depression); an overview of medications; aspects of physician–patient communication; healthy eating; fatigue management; action planning; feedback; and methods for solving problems that result from living with a chronic disease.
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Pain/physical discomfort, shortness of breath and tiredness
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Illness intrusiveness
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Health distress
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Self-rated global health
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Health-related behaviours: exercise, communication with health care providers and mental stress management techniques.
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Utilization measures: self-reported visits to general practice, emergency department visits, pharmacy visits, physical therapy visits and hospitalizations.
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Significant improvements in most variables at six months, except for self-rated health, disability, stretching, hospitalizations, and nights in the hospital.
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Continued improvement at one year, with six of seven health indicators showing statistical significance; disability showed no change.
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Significant improvements in all four health behaviors.
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Statistically significant reductions in general practitioner visits, pharmacy visits, and emergency department visits (P < 0.012).
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Both self-efficacy and satisfaction with the healthcare system improved significantly.
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The peer-led online program conditions led to decreased symptoms, improved health behaviors, enhanced self-efficacy, increased satisfaction with the healthcare system, and reduced healthcare utilization for up to one year
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3 |
| Lorig et al., 2001, USA [49] |
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Cohort study
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613 patients from various hospitals and clinics with different chronic conditions (lung, heart, diabetes, arthritis)
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Statistically significant improvements in various health behaviors, including exercise, cognitive symptom management, and communication with physicians.
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Enhanced self-efficacy in participants, alongside better health status reflected in reduced fatigue, shortness of breath, pain, and depression, and improved role function.
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A notable reduction in healthcare utilization, evidenced by fewer emergency department visits at the one-year mark.
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3 |
| Lee et al., 2022, Australia [50] |
To attain consensus from experts in PF and people living with the disease on the essential components and format of a PF self-management package. |
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Knowledge/skills: Essential components: understanding treatment options for pulmonary fibrosis; understanding and accessing clinical trials; managing medications (including side-effects); role of oxygen therapy; managing shortness of breath; managing fatigue; managing coexisting medical conditions; managing mood; role and importance of pulmonary rehabilitation and regular physical activity; smoking cessation advice and support; accessing community support; how to communicate with others when living with PF. Desirable components: understanding pulmonary fibrosis; understanding expected disease course and prognosis; managing oxygen therapy; advance care planning and advance directives; recognizing an exacerbation. Optional components: managing cough; reducing the risk of exacerbation; vaccinations; using an action plan; nutrition and dietary advice; managing activities of daily living; managing sexual problems; role and importance of social support; accessing peer support; support for carers and family; accessing reliable information about PF; preparation for a medical consultation; monitoring and assessment of disease; awareness of potential noxious exposures; advice on traveling. |
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Health-related quality of life.
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Hospital admission.
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Ability to adopt positive health behaviors.
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Ability to manage symptoms.
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In the round-1 survey, 23% of self-management components reached a consensus and were endorsed by the focus group. These components included understanding treatment options, accessing clinical trials, managing medications, shortness of breath, comorbidities, and accessing community support.
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The expert panel suggested eight new components for the PF self-management package: preparation for medical consultation, monitoring and assessing the disease, awareness of potential noxious exposures, managing pain, managing sexual problems, advice on traveling, communication strategies for living with PF, and support for carers and family.
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In the round-2 survey, 18% of components reached a consensus and were endorsed by the focus group. These included managing fatigue, the role of pulmonary rehabilitation, oxygen therapy, smoking cessation advice and support, and communication strategies for living with PF.
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Both groups agreed that self-management required individualization, goal setting, and feedback.
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5 |
| Hermosa et al., 2020, Spain [51] |
To provide further evidence to support prospective recording of daily symptoms as a useful strategy for detecting COPD exacerbations via the Prevexair smartphone app. It also aimed to analyze daily adherence and the frequency and characteristics of acute COPD exacerbations recorded with Prevexair. |
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Compliance with daily records in the app was 66.6% (120 out of 180), with duration compliance of 78.8%, consistent across disease severity, age, and comorbidity variables.
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Lower compliance (P < 0.05) was observed in patients who were active smokers, had greater dyspnea, and were diagnosed with depression and obesity.
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During the study, 262 exacerbations were recorded in the app, with 99 (37.8%) reported exacerbations and 163 (62.2%) unreported exacerbations.
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The daily use of the Prevexair app was feasible and acceptable for patients with COPD, especially those motivated for self-care due to frequent exacerbations.
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Monitoring through the Prevexair app showed significant potential for implementing self-care plans and offered improved diagnosis and management of chronic conditions in COPD patients.
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3 |
| Alharbey et al., 2019, Saudi Arabia [52] |
To design an innovative mobile health (mHealth) application system called “MyLung” that provides complete solutions to increase self-awareness and promote better self-care management. |
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Knowledge: the information technology artifact “MyLung” included an educational module, a risk-reduction module, and a monitoring module. The educational module was designed to increase patient’s level of understanding about COPD by providing reliable educational videos and information. The risk-reduction module comprised features that empower patients with knowledge about ways to avoid risk-related factors.
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Skills: The monitoring module included features that allow patients to self-monitor their symptoms and vitals, including SpO2.
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“MyLung” is an innovative mHealth app system with modules focused on education, risk reduction, and monitoring.
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Patients in the intervention group received a pulse oximeter and training on the app’s features.
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Quantitative study results showed significant improvements in awareness level (P < 0.001), self-efficacy (P = 0.01), and behavioral intention (P = 0.009) among COPD patients using the app.
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Integration of quantitative and qualitative study findings demonstrated the comprehensive impact of the app’s design on patients with COPD.
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2 |
| Reilly et al., 2022, England [53] |
To explore the accessibility and willingness of patients with chronic breathlessness to use an internet-based breathlessness self-management intervention (SELF-BREATHE). |
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Participants reported increased use, acceptance, and normalization of the internet since the COVID-19 pandemic, using it for various purposes including functional needs, self-investment in health and wellbeing, and social interaction.
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The concept of SELF-BREATHE was highly valued by most participants, with a significant majority (95%) with internet access expressing willingness to use it.
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In addition to technical limitations, personal choice and perceived value of the internet were key factors influencing the readiness to use online resources for managing chronic breathlessness.
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5 |
| Dansky & Vasey, 2009, USA [55] |
Evaluate the impact of telehealth-based disease management system on health and functional status related to patients’ self-management of heart failure, utilization of health services, and patients’
satisfaction. |
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Knowledge/skills: Teleheath system after discharge from formal home health services (transmit the disease management program to the patient, collect clinical data and patients’ responses to questions, and transmit these data back to the healthcare provider). |
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The study examined four outcomes: clinical and functional status, self-management, health service utilization, and satisfaction with the Health Buddy system.
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In terms of self-management, the telehealth group surpassed the control group in five of eight aspects, such as increasing diuretic use during symptoms and diligent daily weight recording.
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Telehealth users showed higher engagement in self-care, enhancing disease management through clinical monitoring and nurse interventions.
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Early detection via telehealth could reduce hospital admissions and emergency visits, lowering costs.
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The system provides feedback, promoting self-management behaviors like medication adjustments, potentially preventing clinical crises or dyspnea.
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1 |
