Background Bronchiectasis is a chronic respiratory condition characterised by abnormal and permanent dilation of the bronchi. It is associated with frequent exacerbations, reduced quality of life and significant burden on patients, families and healthcare services. Self-management interventions are advocated by national and international guidelines and benefits in the management of other airway diseases, such as COPD and asthma, are established. Evidence for the efficacy of self-management in bronchiectasis however remains dearth; a Cochrane systematic review found insufficient evidence to determine whether self-management 1interventions benefit people with bronchiectasis (Kelly et al, 2018).
Objectives An integrative systematic review was undertaken to include all research designs to describe the components of self-management support interventions and investigate what works, for whom and in what circumstances.
Methods A comprehensive database search was conducted on seven databases: MEDLINE Ovid, EMBASE Ovid, CINAHL, EBSCO, AMED, Web of Science Core Collection, and CENTRAL. Cluster searching was performed to supplement electronic database searches to maximise the identification of relevant evidence. Qualitative and quantitative evidence was considered if at least two of the following components of self-management support interventions were included: education, exercise, adherence to treatment, symptom monitoring, airway clearance techniques and action plans. Realist synthesis was undertaken to synthesise all eligible studies to produce context-mechanism-outcomes (CMO) configurations to inform the development of an overarching logic model.
Results A total of six eligible studies (n =258) were included in the synthesis (two RCTs, two qualitative studies and two pre-post studies). A summary CMO-configuration identified contexts (adherent patients in a stable condition and patient knowledge of condition) interacted with four mechanisms (e.g. intrinsically motivated patients and sense of ownership and ability to influence direction of care) produced outcomes including improvement in patient confidence, self-efficacy and reduction in hospitalisations (figure 1).
Conclusions Findings from this evidence synthesis broadly corroborate limited evidence about self-management for adult bronchiectasis patients. For future research we recommend targeting components that were least examined (e.g. action planning) with a focus on mental health and the role of social support.
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