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Self-Management Interventions for Facilitating Life Participation for Persons with Kidney Failure

Journal Contribution - Journal Article

Subtitle:A Systematic Review

BACKGROUND: For persons with kidney failure life participation is a critically important outcome, strongly linked to quality of life and mortality. To support patients' self-management abilities, three domains are typically emphasized: medical-management, emotional-management and management of everyday life (i.e. role-management). While role-management is strongly linked to life participation, there is currently limited research on interventions designed to support it. We explored existing self-management interventions that aim to support everyday life functioning, rather than only medical-management.

METHODS: In this systematic review and qualitative meta-synthesis, we searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science and CENTRAL up to April 2022 for interventional studies involving self-management interventions designed, at least partly, to support management of everyday life. Sandelowski and Barosso's guidelines were used to analyze and synthesize the results. A taxonomy of everyday self-management strategies was used to further explore intervention content. Study quality was assessed using the Cochrane Collaboration's risk-of-bias tools. Evidence of effectiveness was summarized and a meta-analysis of eligible outcomes was conducted.

RESULTS: Of 22,667 records, 53 studies were included in the meta-synthesis. The majority of self-management interventions focused on medical-management. Included interventions involved strategies to support eight domains: Activities of daily living, Work and school life, Meaningful occupations, Leisure activities, Mobility and travel, Interpersonal relationships, Role-functioning, and Social participation. Major interventions focused on providing education, skill training, counseling, and cognitive behavioral therapy. Evidence of effectiveness was reported across a wide range of patient-reported outcomes, including (health-related) quality of life, depression, and self-efficacy. Studies were geographically concentrated and of moderate to low quality.

CONCLUSIONS: Despite its well-recognized importance, research on interventions to improve life participation mostly consists of pilot and feasibility studies, and studies of low quality. Interventions are reported heterogeneously, limiting comparability, and are restricted to specific regions and cultures, limiting generalizability.

Journal: Clin J Am Soc Nephrol
ISSN: 1555-9041
Issue: 2
Volume: 19
Pages: 189-201
Publication year:2024