Ruta de navegación
ComparEuRecommendationsWeb
We suggest the intervention (Conditional recommendation)
In patients with COPD the COMPAR-EU COPD panel, suggests in favour of the use of Education delivered in groups, rather than usual care
Justification
The COMPAR-EU COPD panel made a conditional recommendation in favour of Education delivered in groups, rather than usual care, given a balance that probably favours the intervention (very low quality evidence of effects), the cost-effectiveness evaluation that does not favour either the intervention nor usual care, and an intervention that is probably acceptable for the main stakeholders.
Subgroup considerations
Effect of the intervention may differ according to the intensity and duration of the intervention.
Implementation
When implementing SMI in general, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management (for example, beliefs about the importance of self-management for health, beliefs about the usefulness of certain self-management tasks).
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing Education the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management; patient’s cognitive and behavioural skills to self-management.
When implementing SMI delivered in groups the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions); to have adequate skills in monitoring group interactions.
Patients’ level: to know and adapt to the cultural background and/or language of the patient
SoF
EtD
ComparEuEtdsWeb
| QUESTION | |
|---|---|
| 5. Should education delivered in groups vs. usual care be used for adult patients living with COPD? | |
| Population | adult patients living with COPD |
| Intervention | Education delivered in groups See more |
| Comparison | Usual Care |
| Main outcomes | COPD symptoms (Dyspnea); Quality of life (generic); Quality of life (specific); Coping with the disease (Anxiety); Coping with the disease (Depression); |
| Setting | European Union, outpatient care |
| Perspective | Clinical recommendation- Population perspective |
| Background | Chronic Obstructive Pulmonary Disease (COPD) is one of the major causes of morbidity and mortality worldwide. The economic and social burden related to COPD are expected to increase over the coming decades due to the continued exposure to COPD risk factors and the increasing aging of the world’s population. COPD prevalence varies across countries and across different groups within countries (i.e., being male, older and former or current smoker). It is directly related to the prevalence of tobacco smoking, although in many countries out-door and indoor air pollution constitute major risk factors. |
| Conflict of interest |
This work was supported by the EU Horizon 2020 research and innovation programme (grant agreement no. 754936). The funder had no role in developing the protocol or obtaining the results for this study |
| ASSESSMENT | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Priority of problem Is the problem a priority? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
Chronic Obstructive Pulmonary Disease (COPD) is one of the major causes of morbidity and mortality worldwide [1,2]. The economic and social burden related to COPD are expected to increase over the coming decades due to the continued exposure to COPD risk factors and the increasing aging of the world’s population [3]. COPD prevalence varies across countries and across different groups within countries (i.e., being male, older and former or current smoker) [4]. It is directly related to the prevalence of tobacco smoking, although in many countries out-door and indoor air pollution constitute major risk factors [5,6]. References: 1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Bur- den of Disease Study 2010. Lancet. 2012 Dec; 380(9859):2095–128. https://doi.org/10.1016/S0140- 6736(12)61728-0 PMID: 23245604 2. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec; 380(9859):2163–96. https://doi.org/10.1016/S0140- 6736(12)61729-2 PMID: 23245607 3. Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 to 2030. Samet J, editor. PLoS Med. 2006 Nov 28; 3(11):e442. https://doi.org/10.1371/journal.pmed.0030442 PMID: 17132052 4. Whitmore G, Aaron S, Gershon A, Gao Y, Yang J. Influence of country-level differences on COPD prev- alence. Int J Chron Obstruct Pulmon Dis. 2016 Sep; Volume 11:2305–13. https://doi.org/10.2147/ COPD.S113868 PMID: 27698561 5. Eisner MD, Anthonisen N, Coultas D, Kuenzli N, Perez-Padilla R, Postma D, et al. An Official American Thoracic Society Public Policy Statement: Novel Risk Factors and the Global Burden of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2010 Sep; 182(5):693–718. https://doi. org/10.1164/rccm.200811-1757ST PMID: 20802169 6. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009 Aug; 374 (9691):733–43. https://doi.org/10.1016/S0140-6736(09)61303-9 PMID: 19716966 |
|||||||||||||||||||||
| Desirable Effects How substantial are the desirable anticipated effects? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
View summary of findings of network meta-analysis
View summary of findings of component network meta-analysis |
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged the desirable effects as small due to the effect on dyspnea and quality of life, as well as, the little to no effect in other critical outcomes.
The panel considered the possibilty that the effect of the intervention could differ according to the intensity and duration of the intervention.
No data available for the rest of the critical outcomes Important outcomes: FEV1/FVC ratio: 2,1 (-3,59 to 7,79) FEV1: 0,08 (-0,19 to 0,35) FEV1 pred: -1,27 (-9,14 to 6,6) Physical Exercise Capacity: 1,59 (0,55 to 2,62)
Proportion of direct evidence contributing to the final NMA estimate per outcome: Dyspnoea: 100% Anxiety: 0% Depression: 0% Quality of life (Generic): 100%
Component Network Meta-analysis Components with largest contribution: Dyspnea: Education (E) component, Qol: Education (E) and group-based component.
Studies including the SMI: Bestall-2003: - Education sessions and exercise program (consisting of upper and lower limb training and an aerobic component) - 27 face-to-face, 1-hour group sessions - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity
Kunik-2001: - 2 h of COPD education, followed by weekly calls - 1 face-to-face, 2-hour group session; 6 phone calls - Duration 6 weeks - Expected patient (or carer) self-management behaviours: o Clinical management § Condition-specific behaviours
Kunik-2008: - Eight sessions of COPD education (45-minute lectures/15-minute discussions, designed to control for contact time and group social support) - 8 face-to-face, weekly, 1-hour group sessions - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence
Mozaffari-2018: - Educational package on quality of life - 5 face-to-face, 75-minute group sessions - Duration 11 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Early recognition of symptoms
Mularski-2009: - Support groups including group facilitation ground rules, semistructured conversations about various aspects of the disease experience of COPD, matched collection of daily diary and experiential questions, and open time for the group to address issues identified from earlier support group meeting - 8 face-to-face, weekly group sessions (length unclear) - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Clinical management § Condition-specific behaviours
Ninot-2011: - Hospital-based intervention program providing a combination of 8 sessions of supervised exercise with 8 self-management education sessions over a 1-month period - 8 face-to-face, twice weekly, 2-hour group sessions - Duration 4 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence § Early recognition of symptoms
Soler-2006: - Monthly clinical visits to a specialized clinic and a short educational program - 12 face-to-face, monthly group sessions (length unclear) - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction § Health sleep behaviours
Zhu-2018: - A modified 6-form Tai Chi - 36 face-to-face, monthly, 45-minute group sessions - Duration 3 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity
Modeling estimations for long term consequences We used the COMPAR-EU COPD model developed for the cost-effectiveness analysis to also inform about long-term health outcomes. Decision analytic models can provide valuable information for outcomes when empirical evidence is not available or is unfeasible (Trikalinos TA, 2009). The following events were estimated over a lifetime and informed by the NMA effect of each SMI on lung function (FEV1% predicted), exacerbations and symptoms. We suggest cautious interpretation as the certainty of the evidence for those input parameters was low to very low across comparisons. Long-term model outcomes: - Life-Years (LY): no change per patient - Total exacerbations: no change per patient over lifetime - Severe exacerbations (defined as hospitalization): no change per patient over lifetime |
||||||||||||||||||||||
| Undesirable Effects How substantial are the undesirable anticipated effects? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
View summary of findings of network meta-analysis
No undesirable observed effects. |
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged the undesirable effects as trivial or marginal, or causing no undesirable effects, except for the potential associated burden of the intervention.
The panel agreed that the burden could vary according to the intensity of monitoring. |
||||||||||||||||||||||
| Certainty of the evidence What is the overall certainty of the evidence of effects? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
||||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged the certainty of evidence as very low. Certainty of the evidence was downgraded due to heterogeneity (of interventions and severity of disease), risk of bias, and imprecision. |
||||||||||||||||||||||
| Values Is there important uncertainty about or variability in how much people value the main outcomes? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
An overview of systematic reviews provided information about how patients value several of the outcomes of interest (critical/important) included in this clinical question:
CERQUAL (assessing 3 domains Coherence, Relevance, Adequacy)
|
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged that there is probably no important uncertainty or variability on how patients value the main outcomes.
The panel agreed that there is some variability on how patients value the outcomes, since preferences will vary based on patients' particular starting point, and their disease progression. The panel also noted, that the variability on how patients value the main outcomes, could also depend on the intensity of monitoring. |
||||||||||||||||||||||
| Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
||||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged that the balance of effects probably favours the intervention. This is due to the small desirable effects, the trivial undesirable effects, the probably no important uncertainty and variability on how patients value outcomes, as well as the very low certainty of evidence of effects. |
||||||||||||||||||||||
| Resources required How large are the resource requirements (costs)? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
Estimated costs for the intervention across all types of self-management interventions (SMIs), as described in the included studies of the network meta-analysis, were on average 972 euros per patient, with a range from 53 to 2,921 euros.
Please note that this average/range estimate has been based on ten cost estimates of SMIs for COPD reported in publications.
Model analyses showed that over lifetime the total costs (without cost of the intervention) for SMI were equal to the costs of usual care.
References:
|
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
Despite the scarcity of data in available publications, and the important variability in the characteristics of self-monitoring interventions the panel considered that the resources required varies for this SMI.
Resource use and costing data for SMIs should be interpreted with caution. We could not provide cost for any specific type of SMI intervention, because in many publications detailed information needed to estimate the intervention cost was missing (for example number of sessions, average group size or duration of sessions). As an alternative, we searched for intervention cost estimates as presented by the authors of publications and used the average value as an estimate of the average costs of SMI programs for COPD in general.
|
||||||||||||||||||||||
| Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
||||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel agreed on a very low certainty of the evidence on this domain.
Resource use and costing data for SMIs should be interpreted with caution. We could not provide cost for any specific type of SMI intervention, because in many publications detailed information needed to estimate the intervention cost was missing (for example number of sessions, average group size or duration of sessions). As an alternative, we searched for intervention cost estimates as presented by the authors of publications and used the average value as an estimate of the average costs of SMI programs for COPD in general. |
||||||||||||||||||||||
| Cost-effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
The table below shows the cost-effectiveness results for the SMI intervention. Costs and QALYs in this analysis were discounted at 3.5% annual rate.
NA: not applicable; QALY: quality adjusted life years; ICER: incremental cost-effectiveness ratio Explanations a.The model used the following input parameters from the NMA: FEV1% predicted, exacerbations and symptoms b.Inconsistency: the costing analysis for the intervention showed inconsistent measurements which precluded us from providing specific interventions costs. c. For the headroom analysis a threshold of 20,000 Euro or 50,000 Euro per QALY was used to consider an intervention to be cost-effective.
Headroom Analyses: Headroom analysis is an alternative to conducting a full cost-effectiveness analysis. This is a threshold approach, which determines the maximum amount that could be spent on an intervention to still be regarded as cost-effective, also known as the maximum reimbursable price (MRP) (Girling, Lilford, Cole, & Young, 2015) At a 20,000 euro per QALY threshold, the resulting headroom estimate is:
References:
|
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged that the cost-effectiveness does not favor either the intervention or the comparison
There is a possibility that this specific SMI can be cost-effective, but this depends on the intervention costs of the particular intervention and the threshold used. The intervention may cost 449 euro maximum (headroom estimate) when a threshold value of 20,000 euro/QALY is used and 1,112 euro maximum when a threshold value of 50,000 euro/QALY is used. Both cost estimates are within the observed range of cost estimates of SMI in the literature (average 972 euro, range: 53 to 2,921) (see below for an explanation of headroom analysis. |
||||||||||||||||||||||
| Equity What would be the impact on health equity? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
No specific systematic review was conducted for this domain |
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The panel agreed that the impact on health equity varies, due to the variability across European countries on the levels of health literacy and socioeconomic status. Equity may be affected by geography and accessibility.
If implemented, tailored to culture and health literacy, it may increase equity. |
||||||||||||||||||||||
| Acceptability Is the intervention acceptable to key stakeholders? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups, peers) of self-management interventions according to stakeholders.
References Clari, M., Ivziku, D., Casciaro, R., & Matarese, M. (2018, 02). The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings. COPD, 15(1), 79-88. https://doi.org/10.1080/15412555.2017.1417373 Clari, M., Matarese, M., Ivziku, D., & De Marinis, M. G. (2017, 08). Self-Care of People with Chronic Obstructive Pulmonary Disease: A Meta-Synthesis. Patient, 10(4), 407-427. https://doi.org/10.1007/s40271-017-0218-z Holmen, H., Larsen, M. H., Sallinen, M. H., Thoresen, L., Ahlsen, B., Andersen, M. H., Borge, C. R., Eik, H., Wahl, A. K., & Mengshoel, A. M. (2020, Feb 10). Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies. BMC Health Serv Res, 20(1), 98. https://doi.org/10.1186/s12913-019-4826-2 Swift, E., O'Brien, M. R., Peters, S., & Kelly, C. (2020, Jun 01). Healthcare professionals' perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis. Disabil Rehabil, 1-16. https://doi.org/10.1080/09638288.2020.1769745
See additional considerations for studies interventions from NMA |
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel has judged that this type of SMI is probably acceptable to key stakeholders.
Patients/caregivers: overall acceptable but may vary since it could be influenced by setting, accessibility, tailoring, and other factors. (drop-out varies 0-20%)
Healthcare perspective: It could be time and resources consuming
Healthcare payers perspective: overall acceptable.
Studies' Interventions Bestall-2003: - Education sessions and exercise program (consisting of upper and lower limb training and an aerobic component) - 27 face-to-face, 1-hour group sessions - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity
Kunik-2001: - 2 h of COPD education, followed by weekly calls - 1 face-to-face, 2-hour group session; 6 phone calls - Duration 6 weeks - Expected patient (or carer) self-management behaviours: o Clinical management § Condition-specific behaviours Kunik-2008: - Eight sessions of COPD education (45-minute lectures/15-minute discussions, designed to control for contact time and group social support) - 8 face-to-face, weekly, 1-hour group sessions - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence
Mozaffari-2018: - Educational package on quality of life - 5 face-to-face, 75-minute group sessions - Duration 11 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Early recognition of symptoms
Mularski-2009: - Support groups including group facilitation ground rules, semistructured conversations about various aspects of the disease experience of COPD, matched collection of daily diary and experiential questions, and open time for the group to address issues identified from earlier support group meeting - 8 face-to-face, weekly group sessions (length unclear) - Duration 8 weeks - Expected patient (or carer) self-management behaviours: o Clinical management § Condition-specific behaviours
Ninot-2011: - Hospital-based intervention program providing a combination of 8 sessions of supervised exercise with 8 self-management education sessions over a 1-month period - 8 face-to-face, twice weekly, 2-hour group sessions - Duration 4 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction o Clinical management § Condition-specific behaviours § Medication use and adherence § Early recognition of symptoms
Soler-2006: - Monthly clinical visits to a specialized clinic and a short educational program - 12 face-to-face, monthly group sessions (length unclear) - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity § Smoking cessation or reduction § Health sleep behaviours
Zhu-2018: - A modified 6-form Tai Chi - 36 face-to-face, monthly, 45-minute group sessions - Duration 3 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Doing physical activity
|
||||||||||||||||||||||
| Feasibility Is the intervention feasible to implement? |
||||||||||||||||||||||
| JUDGEMENT | RESEARCH EVIDENCE | |||||||||||||||||||||
|
|
The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups,peers) of self-management interventions according to stakeholders.
References
See acceptability for study interventions from NMA
|
|||||||||||||||||||||
| ADDITIONAL CONSIDERATIONS | ||||||||||||||||||||||
|
The guideline panel judged that the feasibility of implementing this type of SMI varies.
Implementation may be difficult, depending on the context and the use of specific devices for monitoring, for example, online feedback could be more complicated to obtain in certain contexts. and may depend on resources availablity.
Lack of human resources, healthcare system coordination and transport services may make the implementation difficult.
Usually, duration of follow-up was not provided in the studies. |
||||||||||||||||||||||
| TYPE OF RECOMMENDATION | ||||
|---|---|---|---|---|
| Strong recommendation against the intervention | Conditional recommendation against the intervention | Conditional recommendation for either the intervention or the comparison | Conditional recommendation for the intervention | Strong recommendation for the intervention |
| CONCLUSIONS |
|---|
| Recommendation |
|
In patients with COPD the COMPAR-EU COPD panel, suggests in favour of the use of Education delivered in groups, rather than usual care (conditional, very low certainty of the evidence about the effects). |
| Justification |
|
The COMPAR-EU COPD panel made a conditional recommendation in favour of Education delivered in groups, rather than usual care, given a balance that probably favours the intervention (very low quality evidence of effects), the cost-effectiveness evaluation that does not favour either the intervention nor usual care, and an intervention that is probably acceptable for the main stakeholders. |
| Subgroup considerations |
|
Effect of the intervention may differ according to the intensity and duration of the intervention. |
| Implementation considerations |
|
When implementing SMI in general, the most important contextual factors to keep in mind are:
When implementing Education the most important contextual factors to keep in mind are:
When implementing SMI delivered in groups the most important contextual factors to keep in mind are:
|
| Monitoring and evaluation |
|
No suggestions. |
| Research priorities |
|
- Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished. -Future studies should be patient specific from a person-centred care perspective.
|
| REFERENCES SUMMARY |
|---|
Summary of findings of network meta-analysis
COMPAR-EU Web Isof
Summary of findings of component network meta-analysis
COMPONENT NETWORK META-ANALYSIS (sensitivity analysis)
Outcome | Components’ effect (95% Confidence Interval) | CNMA effect (95% Confidence Interval) | |
E | G | ||
Dyspnoea | - 0,84 (-1.12 to -0.49) | 0,18 (-0,67 to 1,03) | -0,66 (-1,47 to 0,15) |
Quality of life (generic) | 0,52 (-0,04 to 1,08) | 4,85 (3,27 to 6,43) | 5,37 (3,89 to 6,85) |
Components' definition:
E: Education; G: Group-based
Components
Education (E)
Education (E)
Sharing information. This form of support consists in sharing of information about self-management topics like coping with symptoms, diet, exercise, medication, information about what other people are doing, and information about the disease itself, or about any other relevant aspects that could lead to improved self-management, and ultimately better health. This information can be told or distributed in printed materials like a folder or workbook, or via website or DVD.
Examples: Educational session on healthy eating for people with obesity, provision of a printed leaflet on the importance of foot care in diabetes, or a link to a website with information on chronic obstructive pulmonary disease care.
In group
Two or more patients or caregivers receive a self-management intervention. Group interventions are normally organized for efficiency purposes or to facilitate learning and knowledge exchange among peers (people living with the same health condition). For example, peer-led education group to enhance physical activity in obese individuals.
Face-to-face
Self-management support delivered in a face-to-face encounter between the providers and patients and/or caregivers.
| Actividad física / Fortaleza muscular [EPOC] | Hacer frente a la enfermedad, incluida la depresión y la ansiedad [EPOC] | Síntomas de la EPOC (a corto plazo) [EPOC] | Función pulmonar [EPOC] | Calidad de vida [EPOC] | |
|---|---|---|---|---|---|
| Educación impartida en sesiones grupales | |||||
| Ver consideraciones para la práctica |
Evidence table description for recommendations section
To enter the decision aids section please press "start".
Aspectos prácticos
Research priorities
- Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished.
- Future studies should address also preferences and values of patients in relation to their self management, cost effectiveness and sub-categories of self-monitoring interventions.
- Future studies should describe in detail the aspects of the intervention and evalute the long term effectiveness.
- Future studies should address smoking cessation
- Future studies should focus on hospitalizations (not just ER visits) because of the HCRU and costs.
- Future studies should incorporate Patient representatives to participate as advisors and when necessary as controllers.
-Future studies should be patient specific from a person-centred care perspective.
Critical outcomes
1. Self efficacy
2. COPD symptoms (Dyspnea)
3. Exacerbation
4. Coping with the disease (anxiety, depression)
5. Emergency room visits (all cause ADM, COPD ADM)
6. Mortality
7. Quality of life
Important outcomes
1. Taking medication or other treatment as advised (adherence) and adherence to regular visits
2. Physical activity—muscle strength
3. Caregiver knowledge and competence
4. Sleep quality
5. Caregiver quality of life
6. Cost-effectiveness and resources
7. Lung function
Another outcomes:
- Physical activity + education (COPD School) vs Physical activity Sistemic inflammation evaluation
Background
Chronic Obstructive Pulmonary Disease (COPD) is one of the major causes of morbidity and mortality worldwide. The economic and social burden related to COPD are expected to increase over the coming decades due to the continued exposure to COPD risk factors and the increasing aging of the world’s population. COPD prevalence varies across countries and across different groups within countries (i.e., being male, older and former or current smoker). It is directly related to the prevalence of tobacco smoking, although in many countries out-door and indoor air pollution constitute major risk factors.
