Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes: A Systematic Review.
Jorge Palacios, Geraldine A Lee, Maria Duaso and 4 others
PMID 28107251WHAT IT FOUND
Internet-delivered self-management support for coronary heart disease showed some positive effects on mood and engagement, but evidence was too heterogeneous to determine overall effectiveness.
Personalization and support components appeared important for engagement, but definitive conclusions on clinical outcomes cannot be drawn.
Key findings
01The review included 7 randomized controlled trials with 1321 participants, finding considerable heterogeneity in intervention content and outcomes that prevented meta-analysis.
02Most studies reporting significant positive effects used personalized feedback, but data were insufficient to determine the effectiveness of other intervention components.
03Evidence for improving mood was limited: only 1 of 4 studies examining this outcome found a statistically significant improvement in the intervention group compared with controls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Considerable heterogeneity between studies in intervention content and outcomes prevented meta-analysis. Many studies relied on subjective, self-reported outcomes rather than objective physiological measures. Blinding was often lacking, introducing risk of performance and detection bias. Attrition rates were high in some studies, which may indicate poor acceptability or bias in results. The review did not include unpublished trials or contact authors for missing data. Few studies tested self-efficacy, a key mechanism for self-management success.
Declared interests
Several authors (G.L., A.C., I.J.N., D.R., and E.A.B.) are involved in the development of an Internet-delivered intervention for people with cardiovascular disease and psychological distress called 'Space From Heart Disease.' The review was conducted to inform the development of this specific intervention.
The easy way to misread this
Do not interpret the positive engagement findings as evidence that Internet-delivered self-management improves clinical outcomes like mortality or physiological health. The review explicitly states that overall effectiveness could not be determined due to heterogeneity, and the authors have a conflict of interest in developing one of the interventions studied.