Work

Effectiveness of nurse-led self-management interventions on healthcare utilisation and clinical outcomes in adults with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Year: 2026

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Chronic obstructive pulmonary disease (COPD) places a sustained burden on healthcare systems. Nurse-led self-management interventions are increasingly used in COPD care, but recent trials have not been synthesised, and their effects on healthcare utilisation outcomes such as hospital length of stay (LOS) have not been pooled quantitatively. Objective To systematically review and meta-analyse the effects of nurse-led self-management interventions, compared with usual care, standard practice, or non-nurse-led comparators, on healthcare utilisation and clinical outcomes, and narratively on self-management capabilities and psychosocial well-being, in adults with COPD. Methods We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and its literature-search extension (PRISMA-S). PubMed, Scopus, ProQuest, ScienceDirect, and ClinicalKey for Nursing were searched for studies published from January 2015 to 31 January 2026, and English-language publications were included. Eligible studies were randomised controlled trials (RCTs) and quasi-experimental studies in adults with COPD comparing nurse-led self-management with usual care, standard practice, or non-nurse-led comparators and reporting healthcare utilisation, clinical, self-management, or psychosocial outcomes. RCTs and quasi-experimental studies were pooled together; only one quasi-experimental study contributed to a meta-analysis (CAT scores). Methodological quality was appraised using Joanna Briggs Institute (JBI) critical appraisal tools, and all studies were retained regardless of appraisal score. Effects were pooled as standardised mean differences (SMDs) or mean differences (MDs) using random-effects models, except for hospital LOS, for which a fixed-effect model was used as the primary analysis, with a random-effects model as a sensitivity analysis. The review was not prospectively registered, and the outcome criterion for eligibility was broadened during peer review without affecting any meta-analysis. Results Fourteen studies (9 RCTs, 5 quasi-experimental) were included from 1,396 records; six were of high quality and one was of low quality. Nurse-led interventions were associated with a shorter hospital LOS of approximately one day (2 RCTs; MD = − 1.02 days, 95% CI − 1.73 to − 0.32), although one trial contributed 94.5% of the weight. Pooled estimates for emergency department (ED) visits (MD = − 0.62, 95% CI − 1.27 to 0.03), COPD Assessment Test (CAT) scores (SMD = − 0.42, 95% CI − 0.93 to 0.10), hospital admissions, and 6-minute walk test (6MWT) distance were not statistically significant. In exploratory post hoc leave-one-out analyses, omitting one trial with a conventional nurse-led education comparator produced a significant reduction in ED visits (two remaining studies) and a borderline reduction in CAT scores (SMD = − 0.55, 95% CI − 1.09 to − 0.00). Conclusion Nurse-led self-management was associated with a shorter hospital LOS in adults with COPD, but the certainty of evidence was very low for this and all other outcomes. Apparent reductions in ED visits and symptom burden emerged only in post hoc sensitivity analyses. Adequately powered trials with standardised comparators are needed to confirm these findings. Clinical trial number Not applicable.

Source: BMC Nursing

DOI: 10.1186/s12912-026-05502-1