Table 2. Overall Effect Sizea at 4 to 6 Months and 9 to 12 Months for English-Speaking Small Group Interventions (n = 22), Meta-Analysis of the Chronic Disease Self-Management Program, Studies Published 1999–2009.
| Outcome | 4–6 Months (n = 15) |
9–12 Months (n = 7) |
||
|---|---|---|---|---|
| No. of Studies (References) | Effect Size (95% CI) | No. of Studies (References) | Effect Size (95% CI) | |
| Health behavior | ||||
| Aerobic exercise | 9 (1,7,9,22,24–28) | 0.12b (0.04 to 0.19) | 3 (7,9,21) | 0.10b (0.001 to 0.20) |
| Cognitive symptom management | 9 (1,9,15,16,24–26,28,30) | 0.26b (0.16 to 0.36) | 4(8,9,15,21) | 0.37b (0.26 to 0.48) |
| Communication with physician | 8 (1,15,16,22,26–28,30) | 0.26b (0.08 to 0.42) | 3 (8,15,21) | 0.24 (−0.03 to 0.51) |
| Stretching/strengthening exercise | 9 (1,7,9,16,24–28) | 0.12 (−0.006 to 0.24) | 2 (7,9) | 0.15b (0.007 to 0.30) |
| Psychological health status | ||||
| Depressionc | 6 (15,24–26,28,30) | −0.22b (−0.30 to −0.13) | 3 (8,15,21) | −0.21b (−0.28 to −0.13) |
| Health distressc | 12 (1,2,7,9,16,22,24–28,30) | −0.28b (−0.36 to −0.20) | 5 (7–9,20,21) | −0.23b (−0.32 to −0.13) |
| Overall self-efficacy | 5 (2,15,16,19,22) | 0.35b (0.19 to 0.49) | 3 (15,20,21) | 0.20b (0.08 to 0.33) |
| Self-efficacy for chronic disease management | 6 (7,24–26,28,30) | 0.26b (0.11 to 0.40) | 2 (7,8) | 0.38b (0.04 to 0.71) |
| Self-efficacy for management of other symptoms | 6 (24–28,30) | 0.28b (0.18 to 0.38) | 1 (8) | 0.45b (0.29 to 0.61) |
| Physical health status | ||||
| Energy | 8 (1,2,16,17,24–26,28) | 0.16b (0.02 to 0.29) | 1 (20) | 0.05 (−0.02 to 0.13) |
| Fatiguec | 10 (7,9,15,22,24–28,30) | −0.14b (−0.25 to −0.02) | 5 (7–9,15,21) | −0.14 (−0.31 to 0.04) |
| Functional disabilityc | 8 (1,7,9,16,24–26,28) | −0.06 (−0.01 to 0.05) | 5 (7–9,20,21) | 0.05 (−0.003 to 0.10) |
| Painc | 10 (7,9,15,22,24–28,30) | −0.13 (−0.27 to 0.01) | 5 (7–9,15,21) | −0.13b (−0.20 to −0.05) |
| Self-rated health | 11 (1,2,7,9,16,22,24–28) | 0.14b (0.03 to 0.26) | 4 (7,9,20,21) | −0.02 (−0.13 to 0.09) |
| Social role limitationsc | 9 (1,2,7,9,16,22,26–28) | −0.17b (−0.21 to −0.12) | 4 (7,9,20,21) | −0.14b (−0.28 to −0.002) |
| Shortness of breathc | 8 (1,22,24–28,30) | −0.08 (−0.84 to 0.40) | 2 (8,21) | −0.10b (−0.17 to −0.03) |
| Health care utilization | ||||
| Emergency department visitsc | 4 (16,22,26,27) | −0.02 (−0.08 to 0.05) | 2 (20,21) | −0.10 (−0.22 to 0.02) |
| Physician visitsc | 9 (2,7,9,16,22,24,26,27,30) | −0.04 (−0.08 to 0.02) | 4 (7,9,20,21) | −0.08 (−0.17 to 0.01) |
| Hospitalization days or nightsc | 8 (1,2,9,16,22,24,26,27) | −0.09b (−0.15 to −0.02) | 3 (9,20,21) | −0.04 (−0.09 to 0.02) |
| Hospitalization timesc | 7 (1,7,9,16,24,26,27) | −0.01 (−0.06 to 0.05) | 4 (7,9,20,21) | −0.003 (−0.12 to 0.12) |
Abbreviation: CI, confidence interval.
a
Fifteen studies (5 randomized controlled trials and 10 longitudinal evaluations) were examined at 4 to 6 months and 7 studies (1 randomized controlled trial and 6 longitudinal evaluations) at 9 to 12 months. Effect size is the combination of the standardized differences in means for all eligible studies.
b
P < .01, determined by z score test for significance of pooled effect size.
c
Negative effect size indicates positive effect (eg, a decrease in depression).