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

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.

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    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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