Publications

BACKGROUND:

Self-monitoring is increasingly recommended as a method of managing cardiovascular disease; however, the effectiveness reported in different clinical trials varies substantially. In order to better understand this variability, we examined the interventions included in systematic reviews of self-monitoring for four clinical problems that increase cardiovascular disease risk.

METHODS:

We searched Medline and Cochrane databases for systematic reviews of self-monitoring for: heart failure, oral anticoagulation therapy, hypertension and type 2 diabetes. We extracted data using a pre-specified template for the identifiable components of the interventions for each disease. Data was also extracted on the theoretical basis of the education provided, the rationale given for the self-monitoring regime adopted and the compliance with the self-monitoring regime by the patients.

RESULTS:

From 52 randomized controlled trials (10,388 patients) we identified three main components in self-monitoring interventions: education; self-measurement and adjustment/adherence. Considerable variation in these components occurred across trials and conditions, and often components were poorly described. Few trials gave evidence-based rationales for the components included and self-measurement regimes adopted.

CONCLUSIONS:

The components of self-monitoring interventions are not well defined despite current guidelines for self-monitoring in cardiovascular disease management. Few trials gave evidence-based rationales for the components included and self-measurement regimes adopted. We propose a checklist of factors to be considered at each stage in the design of self-monitoring interventions which will aide in the provision of an evidence-based rationale for each component as well as increase the reproducibility of effective interventions for clinicians and researchers.