EFFECTIVENESS OF PATIENT ACTIVATION INTERVENTIONS ON OLDER ADULTS WITH CHRONIC DISEASE : A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background – With the onset of a global ageing population, prevalence of older adults and elderly suffering from chronic diseases has increased. PAI aims to reinforce the patient’s responsibility by cultivating better understanding, confidence and competence towards self-care which has much potential in maintaining and preventing exacerbation of chronic illnesses. Objectives – This review aims to synthesise available evidence related to PAIs and the effectiveness of these interventions in promoting PA for older adults with chronic diseases. Selection Criteria – Studies are included if they: (1) are RCTs on PAIs for older adults with chronic diseases; (2) include interventions aimed at increasing PA; (3) have outcomes reporting PA; (4) published in English language. Searching Strategy – A literature search of trials from Electronic databases such as CINAHL, Cochrane, EMBASE, Google Scholar, PROQUEST, PubMed, ScholarBank@NUS, Scopus, and Web of Science were searched from January 2004 till October 2018. Data Extraction and Synthesis – Pertinent data was extracted from RCTs using a standardised extraction form and the risk of bias was assessed by two independent reviewers. Overall effect was assessed using effect size and z-statistics through RevMan 5.3. Heterogeneity was evaluated using x2 and I2 values. Results – A total of 4,805 records were identified with four selected RCTs with 2,309 older adults suffering from chronic diseases. The review discovered a large effect size (d = 0.95) favouring PAIs on PAM score. Subgroup analysis revealed no significant difference regarding the two major components of PAIs. Conclusion – This review provided evidence to support the use of PAIs to enhance PA in older adults with chronic diseases. Implications of the Study – This review’s findings enable healthcare professionals to gain a deeper understanding on ways to increase PA to enhance patient care. This also provides ideas for further research and development of more effective PAIs.