| 1. Qualiy of life / Quality of life (specific-disease instruments) |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| -0.6 [-1.61, 0.4] |
Low |
It may result in a slight increase in quality of life (specific-disease instruments) |
0 |
0 |
[, ] |
N/A |
N/A |
-0.6 [-1.61, 0.4] |
Low |
| 2. Coping with the disease, including depression and anxiety / Anxiety |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.51 [-0.35, 1.36] |
Low |
It may result in a slight increase in anxiety |
0 |
0 |
[, ] |
N/A |
1.0 |
0.51 [-0.35, 1.36] |
0.0 |
| 3. Qualiy of life / Quality of life (generic instruments) |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.22 [-1.13, 1.57] |
Very low |
It may have little to no effect on quality of life (generic instruments) |
0 |
0 |
[, ] |
N/A |
1.0 |
0.22 [-1.13, 1.57] |
Low |
| 4. Coping with the disease, including depression and anxiety / Depression |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.28 [-0.65, 1.21] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
0 |
0 |
[, ] |
N/A |
N/A |
0.28 [-0.65, 1.21] |
Low |
| 5. Number of emergency room visits and admissions / All-cause hospital admissions |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| -9.189960000000001 [-28.256249999999998, 38.161350000000006] |
Moderate |
It likely results in little to no difference in all cause admission |
2 |
116 |
-0.25 [-1.16, 0.66] |
Moderate |
0.0 |
N/A |
NA |
| 6. Physical activity / Muscle strenght / Exercise capacity |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 1.17 [-0.58, 2.92] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
1 |
57 |
39.62 [31.93, 47.32] |
Low |
0 |
-0.93 [-2.73, 0.87] |
Low |
| 7. Number of emergency room visits and admissions / Emergency room/department visits |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| 0.6605 [0.4143, 1.0528] |
Low |
It may have little to no effect in emergency room admission |
4 |
246 |
-0.41 [-0.88, 0.05] |
Moderate |
0.0 |
N/A |
NA |
| 8. Number of emergency room visits and admissions / COPD-related hospital admissions |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| -21.857487510000002 [-36.691645699999995, 3.149998200000003] |
Moderate |
It likely results in little to no difference on COPD-related hospital admissions |
2 |
95 |
-0.62 [-1.33, 0.09] |
Moderate |
1.0 |
-0.29 [-1.06, 0.48] |
Low |
| 9. Lung Function / FEV1 (% pred) - forced expiratory volume |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 2.57 [-1.56, 6.7] |
Very low |
It may have little to no effect on FEV1 (% pred) but the evidence is very uncertain |
1 |
52 |
2.57 [-1.56, 6.7] |
Low |
0.0 |
N/A |
NA |
| 10. Lung Function / FEV1/FVC ratio - forced expiratory volume in the first one second to the forced vital capacity of the lungs |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
| 0.06 [0.05, 0.07] |
Low |
It may result in little to no difference in FEV1/FVC |
1 |
57 |
0.06 [0.05, 0.07] |
Low |
0.0 |
N/A |
NA |
| 11. Exacerbation / Exacerbations |
| NMA |
Direct |
Indirect |
| Anticipated absolute effects (95% CI) - Difference |
Certainty of the evidence |
Interpretation of findings |
Number of studies |
Number of patients |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| -29.3538102 [-37.202022, -7.552759499999999] |
Low |
It may result in little to no difference in exacerbations |
1 |
52 |
-1.22 [-2.24, -0.2] |
Low |
0.0 |
N/A |
NA |
Footnotes per outcome:
1) a) We rated down the certainty of evidence due to serious risk of bias, serious imprecision;b) Number of studies included in the network: 8 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: comparison(s).
2) a) We rated down the certainty of evidence due to serious of bias and serious imprecision; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 1 comparison(s).
3) a) We rated down the certainty of evidence due to serious of bias and very imprecision; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: 0 comparison(s).
4) a) We rated down the certainty of evidence due to serious risk of bias, and very serious imprecision;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: comparison(s).
5) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=60); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 3 - 12 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to serious risk of bias
6) We rated down the certainty of evidence due to very serious imprecision
7) We rated down the certainty of the evidence due to very serious risk of bias
8) a) We rated down the certainty of evidence due to serious risk of bias;b) Number of studies included in the network: 21 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=48); Number of comparison(s) informing the indirect estimate: 1 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 6 -9 months in the studies directly comparing the self-management intervention versus usual care.
9) a) We rated down the certainty of evidence due to very serious risk of bias, and serious imprecision;b) Number of studies included in the network: 32 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=27); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 9 months in the studies directly comparing the self-management intervention versus usual care.
10) a) We rated down the certainty of evidence due to very serious risk of bias; b) Number of studies included in the network: 18 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=29); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 4 months in the studies directly comparing the self-management intervention versus usual care.
11) a) We rated down the certainty of evidence due to very serious risk of bias;b) Number of studies included in the network: 15 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=25); Number of comparison(s) informing the indirect estimate: 0 comparison(s). The range of follow up was from 1 to 24 months for the studies included in the whole network. The range of follow-up was 9 months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
5) De San Miguel-2013, Jodar-Sanchez-2014
6) Liu-2013a
7) De San Miguel-2013, Ho-2016, Jodar-Sanchez-2014, Tabak-2014
8) De San Miguel-2013, Tabak-2014
9) Jehn-2013
10) Liu-2013a
11) Jehn-2013
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