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Research

Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.1308 (Published 12 June 2003) Cite this as: BMJ 2003;326:1308

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  • Table A  Characteristics of included trials

    Table B Methodological quality of included trials

    References
     

    Table A  Characteristics of included trials
     

    Trial
    Trial design
    No of patients (% followed up)
    Mean age (range)
    Asthma severity
    Session type
    No of sessions
    Basis of self management strategy
    Educational strategy
    Duration of intervention (months)
    Alexander 1988w1Randomised controlled trial
    21 (100)
    Not reported (2-13)
    		Moderate-severeIndividual
    4
    		SymptomsPrevention, attacks
    12
    Carswell 1989w2Randomised controlled trial
    86 (100)
    11.2 (5-15)
    		Mild-moderateIndividual
    ³1
    		Peak flowPrevention, attacks
    6
    Charlton 1994w3Randomised controlled trial
    91 (87)
    6.5 (3-16)
    		UnclearIndividual
    1
    		Peak flowPrevention, attacks
    1
    Christiansen 1997w4Controlled clinical trial
    50 (84)
    10.4 (9-12)
    		Moderate-severeGroup
    5
    		Peak flowPrevention, attacks
    1
    Clark 1986w5Randomised controlled trial
    308 (83)
    9.2 (4-17)
    		UnclearGroup
    6
    		SymptomsPrevention, attacks, social skills
    6
    Colland 1993w6Randomised controlled trial
    112 (100)
    10 (8-12)
    		UnclearGroup
    10
    		SymptomsPrevention, attacks, social skills
    2.5
    Dahl 1990w7Randomised controlled trial
    20 (95)
    12.2 (not reported)
    		Moderate-severeIndividual
    4
    		Peak flowPrevention, attacks, social skills
    1
    Deaves 1993w8Controlled clinical trial
    64 (98)
    Not reported (3-16)
    		Moderate-severeIndividual
    1
    		Peak flowPrevention, attacks
    1
    Evans 1987w9Randomised controlled trial
    239 (85)
    9.1 (8-11)
    		Mild-moderateGroup
    6
    		SymptomsPrevention, attacks, social skills
    1
    Fireman 1981w10Controlled clinical trial
    26 (100)
    7.4 (2-14)
    		Moderate-severeIndividual and group
    6
    		SymptomsPrevention, attacks, social skills
    12
    Hill 1991w11Randomised controlled trial
    451 (66)
    Not reported (5-10)
    		Moderate-severeIndividual and group
    ³1
    		SymptomsAttacks
    12
    Holzheimer 1998w12Randomised controlled trial
    80 (70)
    4.5 (2-6)
    		UnclearGroup
    3
    		SymptomsPrevention, attacks
    4
    Hughes 1991w13Randomised controlled trial
    95 (94)
    9.7 (6-16)
    		Moderate-severeIndividual
    6
    		Peak flowPrevention, attacks
    12
    Kubly 1984w14Randomised controlled trial
    65 (43)
    8.2 (not reported)
    		UnclearGroup
    3-4
    		SymptomsPrevention, attacks
    1
    LeBaron 1985w15Randomised controlled trial
    31 (100)
    10.6 (6-17)
    		Mild-moderateIndividual
    3
    		Peak flowPrevention
    5
    Lewis 1984w16Randomised controlled trial
    88 (86)
    10.3 (7-12)
    		Moderate-severeGroup
    5
    		SymptomsPrevention, attacks, social skills
    1
    Madge 1997w17Randomised controlled trial
    201 (100)
    Not reported (2-15)
    		UnclearIndividual
    3
    		Peak flowPrevention, attacks, social skills
    1
    McNabb 1985w18Randomised controlled trial
    16 (94)
    10.4 (9-13)
    		UnclearIndividual
    5
    		SymptomsPrevention, attacks
    1
    Mitchell 1986w19Randomised controlled trial
    368 (70)
    5.9 (2-14)
    		UnclearIndividual
    6
    		SymptomsPrevention, attacks
    6
    Parcel 1980w20Controlled clinical trial
    104 (100)
    7.7 (5-11)
    		UnclearGroup
    24
    		SymptomsPrevention, attacks, social skills
    6
    Perrin 1992w21Randomised controlled trial
    81 (69)
    9.3 (6-14)
    		Moderate-severeGroup
    4
    		SymptomsPrevention, attacks
    1
    Persaud 1996w22Randomised controlled trial
    36 (100)
    10.2 (8-12)
    		Moderate-severeIndividual
    8
    		Peak flowPrevention, attacks, social skills
    2
    Rakos 1985w23Randomised controlled trial
    43 (100)
    Not reported (7-12)
    		Moderate-severeIndividual
    1
    		SymptomsPrevention, attacks, social skills
    Unclear
    Ronchetti 1997w24Randomised controlled trial
    312 (67)
    9.6 (6-14)
    		Moderate-severeGroup
    4-8
    		SymptomsPrevention, attacks, social skills
    1-2
    Rubin 1986w25Randomised controlled trial
    65 (83)
    9.7 (7-12)
    		Moderate-severeIndividual
    6
    		SymptomsPrevention, attacks
    10
    Shields 1990w26Randomised controlled trial
    253 (81)
    8.8 (<19)
    		UnclearIndividual and group
    8
    		SymptomsPrevention, attacks
    1-2
    Szczepanski1996w27Controlled clinical trial
    84 (89)
    Not reported (not reported)
    		UnclearGroup
    ³11
    		Peak flowPrevention, attacks
    6
    Talabere 1993w28Randomised controlled trial
    50 (100)
    Not reported (8-12)
    		UnclearIndividual
    2
    		SymptomsPrevention, attacks, social skills
    1
    Toelle 1993w29Controlled clinical trial
    132 (91)
    9.2 (8-11)
    		Mild-moderateGroup
    2
    		Peak flowPrevention, attacks
    1
    Weingarten 1985w30Randomised controlled trial
    20 (95)
    Not reported (8-11)
    		UnclearGroup
    26
    		Peak flowPrevention, attacks, social skills
    2.5
    Whitman 1985w31Randomised controlled trial
    38 (100)
    8.4 (6-14)
    		Moderate-severeGroup
    8
    		SymptomsPrevention, attacks
    1
    Wilson 1996w32Randomised controlled trial
    76 (84)
    3.8 (not reported)
    		Moderate-severeGroup
    4
    		Peak flowPrevention, attacks, social skills
    1

     

    Table B Methodological quality of included trials
     

    Trial
    Allocation concealment*
    Systematic differences
    Care provided
    Follow up
    Outcome assessment
    Alexander 1988w1UnclearYesNoNo
    Carswell 1989w2AdequateNoNoNo
    Charlton 1994w3AdequateYesNoNo
    Christiansen 1997w4InadequateNoNoNo
    Clark 1986w5UnclearNoNoNo
    Colland 1993w6UnclearNoNoNo
    Dahl 1990w7UnclearNoNoNo
    Deaves 1993w8InadequateNoNoNo
    Evans 1987w9AdequateNoNoNo
    Fireman 1981w10InadequateNoNoNo
    Hill 1991w11UnclearYesYesNo
    Holzheimer 1998w12UnclearNoYesNo
    Hughes 1991w13AdequateYesNoNo
    Kubly 1984w14AdequateNoYesNo
    LeBaron 1985w15UnclearNoNoNo
    Lewis 1984w16AdequateNoNoNo
    Madge 1997w17AdequateNoNoNo
    McNabb 1985w18AdequateNoNoNo
    Mitchell 1986w19UnclearNoYesNo
    Parcel 1980w20InadequateNoNoNo
    Perrin 1992w21UnclearNoYesNo
    Persaud 1996w22AdequateNoNoNo
    Rakos 1985w23UnclearNoNoNo
    Ronchetti 1997w24UnclearNoYesNo
    Rubin 1986w25AdequateNoYesNo
    Shields 1990w26AdequateNoNoNo
    Szczepanski 1996w27InadequateYesYesNo
    Talabere 1993w28UnclearNoNoNo
    Toelle 1993w29InadequateYesNoNo
    Weingarten 1985w30UnclearNoNoNo
    Whitman 1985w31UnclearNoNoNo
    Wilson 1996w32AdequateNoNoNo

    *Whether allocation to treatment or control group was sufficiently concealed before enrolment.
     
     

    References

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    w2 Carswell F, Robinson EJ, Hek G, Shenton T. A Bristol experience: benefits and cost of an "asthma nurse" visiting the homes of asthmatic children. Bristol Med Chir J 1989;104:11-2.

    w3 Charlton I, Antoniou AG, Atkinson J, Campbell MJ, Chapman E, Mackintosh T, et al. Asthma at the interface: bridging the gap between general practice and a district general hospital. Arch Dis Child 1994;70:313-8.

    w4 Christiansen SC, Martin SB, Schleicher NC, Koziol JA, Mathews KP, Zuraw BL. Evaluation of a school-based asthma education program for inner-city children. J Allergy Clin Immunol 1997;100:613-7.

    w5 Clark NM, Feldman CH, Evans D, Levison MJ, Wasilewski Y, Mellins RB. The impact of health education on frequency and cost of health care use by low income children with asthma. J Allergy Clin Immunol 1986;78:108-15.

    w6 Colland VT. Learning to cope with asthma: a behavioural self-management program for children. Patient Educ Couns 1993;22:141-52.

    w7 Dahl J, Gustafsson D, Melin L. Effects of a behavioral treatment program on children with asthma. J Asthma 1990;27:41-6.

    w8 Deaves DM. An assessment of the value of health education in the prevention of childhood asthma. J Adv Nurs 1993;18:354-63.

    w9 Evans D, Clark NM, Feldman CH, Rips J, Kaplan D, Levison MJ, et al. A school health education program for children with asthma aged 8-11 years. Health Educ Q 1987;14:267-79.

    w10 Fireman P, Friday GA, Gira C, Vierthaler WA, Michaels L. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics 1981;68:341-8.

    w11 Hill R, Williams J, Britton J, Tattersfield A. Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study. BMJ 1991;303:1169-74.

    w12 Holzheimer L, Mohay H, Masters IB. Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education videotape and picture book. Child Care Health Dev 1998;24:85-99.

    w13 Hughes DM, McLeod M, Garner B, Goldbloom RB. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics 1991;87:54-61.

    w14 Kubly LS, McClellan MS. Effects of self-care instruction on asthmatic children. Issues Compr Pediatr Nurs 1984;7:121-30.

    w15 LeBaron S, Zeltzer LK, Ratner P, Kniker WT. A controlled study of education for improving compliance with cromolyn sodium (Intal): the importance of physician-patient communication. Ann Allergy 1985;55:811-8.

    w16 Lewis CE, Rachelefsky G, Lewis MA, De la Sota A, Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics 1984;74:478-86.

    w17 Madge P, McColl J, Paton J. Impact of nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax 1997;52:223-8.

    w18 McNabb WL, Wilson-Pessano SR, Hughes GW, Scamagas P. Self-management education of children with asthma: air wise. Am J Public Health 1985;75:1219-20.

    w19 Mitchell EA, Ferguson V, Norwood M. Asthma education by community child health nurses. Arch Dis Child 1986;61:1184-9.

    w20 Parcel GS, Nader PR, Tiernan K. A health education program for children with asthma. J Dev Behav Pediatr 1980;1:128-32.

    w21 Perrin JM, MacLean WE, Gortmaker SL, Asher KN. Improving the psychological status of children with asthma: a randomized controlled trial. J Dev Behav Pediatr 1992;13:241-7.

    w22 Persaud DI, Barnett SE, Weller SC, Baldwin CD, Niebuhr V, McCormick DP. An asthma self-management program for children, including instruction in peak flow monitoring by school nurses. J Asthma 1996;33:37-43.

    w23 Rakos RF, Grodek MV, Mack KK. The impact of a self-administered behavioral intervention program on pediatric asthma. J Psychosom Res 1985;29:101-8.

    w24 Ronchetti R, Indinnimeo L, Bonci E, Corrias A, Evans D, Hindi-Alexander M, et al. Asthma self-management programmes in a population of Italian children: a multicentric study. Eur Respir J 1997;10:1248-53.

    w25 Rubin DH, Leventhal JM, Sadock RT, Letovsky E, Schottland P, Clemente I, et al. Educational intervention by computer in childhood asthma: a randomized clinical trial testing the use of a new teaching intervention in childhood asthma. Pediatrics 1986;77:1-10.

    w26 Shields MC, Griffin KW, McNabb WL. The effect of a patient education program on emergency room use for inner-city children with asthma. Am J Public Health 1990;80:36-8.

    w27 Szczepanski R, Gebert N, Hummelink R, Konning J, Schmidt S, Runde B, et al. Ergebnis einer strukturlerten asthmaschulung im kindesund jugendalter (Outcome of structured asthma education in childhood and adolescence.) Pneumologie 1996;50:544-8. [In German.]

    w28 Talabere LR. The effects of an asthma education program on selected health behaviors of school-aged children with asthma. In: Funk SG, ed. Key aspects of caring for the chronically ill: hospital and home. New York: Springer, 1993:319-30.

    w29 Toelle BG, Peat JK, Salome CM, Mellis CM, Bauman AE, Woolcock AJ. Evaluation of a community-based asthma management program in a population sample of school children. Med J Aust 1993;158:742-6.

    w30 Weingarten MA, Goldberg J, Teperberg Y. A pilot study of the multidisciplinary management of childhood asthma in a family practice. J Asthma 1985;22:261-5.

    w31 Whitman N, West D, Brough FK, Welch M. A study of a self-care rehabilitation program in pediatric asthma. Health Educ Q 1985;12:333-42.

    w32 Wilson SR, Latini D, Starr NJ, Fish L, Loes LM, Page A, et al. Education of parents of infants and very young children with asthma: a development evaluation of the Wee Wheezers program. J Asthma 1996;33:239-54.
     

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