| 1. 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 |
| -31.97991 [-38.46959999999999, -9.465329999999998] |
Low |
It may result in little to no difference in all cause admission |
0 |
0 |
[, ] |
N/A |
1.0 |
-1.51 [-2.75, -0.26] |
Low |
| 2. 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 |
| -0.76 [-1.2, -0.31] |
Low |
It may result in little to no difference in FEV1 (% pred) |
2 |
110 |
-2.24 [-2.96, -1.52] |
Low |
1.0 |
0.15 [-0.41, 0.72] |
Low |
| 3. 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 |
| 0.3257 [0.1737, 0.6107] |
Low |
It may have little to no effect in emergency room admission |
1 |
85 |
-0.65 [-1.6, 0.29] |
Moderate |
1.0 |
-1.5 [-2.34, -0.65] |
Moderate |
| 4. Mortality / All causes of mortality |
| 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 |
| N/A |
Very low |
It may have little to no effect on mortality (all cause) but the evidence is very uncertain |
2 |
155 |
N/A |
Low |
1.0 |
-0.19 [-1.87, 1.5] |
Low |
| 5. 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 |
| 0.15 [0.05, 0.25] |
Low |
It may result in little to no difference in FEV1/FVC |
1 |
60 |
0.9 [-2.58, 4.38] |
Low |
N/A |
0.15 [0.05, 0.25] |
Low |
| 6. Activities of daily living / Activities of daily living (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 |
| 0.791113968637692 [0.1486, 1.4337] |
Very low |
It may slightly increase activities of daily life but the evidence is very uncertain |
1 |
41 |
0.791113968637692 [0.1486, 1.4337] |
N/A |
N/A |
N/A |
N/A |
| 7. COPD symptoms (short term) / Dyspnea or breathlessness |
| 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 |
| -1.19 [-1.73, -0.64] |
Very low |
It may decrease dysnea but the evidence is very uncertain |
4 |
211 |
-1.49 [-2.24, -0.75] |
Very low |
4.0 |
-0.82 [-1.63, -0.02] |
Very low |
| 8. 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 |
| -0.08 [-0.67, 0.51] |
Very low |
It may have little to no effect on anxiety but the evidence is very uncertain |
2 |
44 |
-0.18 [-0.78, 0.42] |
Low |
2.0 |
3.1 [-0.31, 6.52] |
Low |
| 9. 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 |
| -0.07 [-0.71, 0.57] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
2 |
44 |
-0.14 [-0.8, 0.52] |
Low |
2.0 |
1.75 [-1.57, 5.06] |
Low |
| 10. Lung Function / FEV1 (L/min) - 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 |
| 0.12 [-0.02, 0.26] |
Low |
It may result in a slight increase in FEV1 |
2 |
99 |
0.12 [-0.02, 0.26] |
Moderate |
0.0 |
N/A |
NA |
| 11. 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 |
| -14.828324859999999 [-35.093313280000004, 23.10582012999999] |
Moderate |
It likely results in little to no difference on COPD-related hospital admissions |
2 |
113 |
-0.29 [-0.92, 0.33] |
Moderate |
N/A |
NA [NA, NA] |
NA |
| 12. 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 |
| 0.12 [-0.68, 0.91] |
Very low |
It may have little to no effect on quality of life (generic instruments) |
1 |
39 |
0.31 [-0.88, 1.5] |
Low |
2.0 |
-0.04 [-1.1, 1.03] |
Low |
| 13. 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 |
| -0.54 [-1.0, -0.07] |
Very low |
It may have little to no effect on quality of life (specific-disease instruments) but the evidence is very uncertain |
7 |
261 |
-0.56 [-1.07, -0.04] |
Very low |
27.0 |
-0.44 [-1.53, 0.65] |
Very low |
| 14. 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 |
| 1.08 [0.51, 1.65] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
6 |
238 |
1.33 [0.66, 1.99] |
Very low |
0 |
0.39 [-0.73, 1.51] |
Very low |
Footnotes per outcome:
1) a) Number of studies included in the network: 19 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). 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 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down due to very serious risk of bias
2) a) We rated down the certainty of evidence due to serious risk of bias and inconsistency ;b) Number of studies included in the network: 32 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=60); 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 2- 3 mo months in the studies directly comparing the self-management intervention versus usual care.
3) We rated down the certainty of the evidence due to very serious risk of bias
4) a) We rated down the certainty of evidence due to serious risk of bias, serious inconsistency, and serious imprecision; b) Number of studies included in the network: 15 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=89); 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 12 months in the studies directly comparing the self-management intervention versus usual care.
5) 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: 0 RCT(s) (N=0); Number of comparison(s) informing the indirect estimate: comparison(s).
6) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 41); b)We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision
7) a) We rated down the certainty of evidence due to ,very serious of risk of bias, ;b) Number of studies included in the network: 48 RCTs; Number of studies directly comparing the intervention with usual care: 4 RCT(s) (N=113); Number of comparison(s) informing the indirect estimate: 4 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 2 - 12 months in the studies directly comparing the self-management intervention versus usual care.
8) a) We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=21); Number of comparison(s) informing the indirect estimate: 2 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.
9) a) We rated down the certainty of evidence due to very 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: 2 RCT(s) (N=21); Number of comparison(s) informing the indirect estimate: 2 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.
10) a) We rated down the certainty of evidence due to serious risk of bias and serious imprecision;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=55); 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 2- 12 mo months in the studies directly comparing the self-management intervention versus usual care.
11) 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=62); Number of comparison(s) informing the indirect estimate: 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 1 - 12 months in the studies directly comparing the self-management intervention versus usual care.
12) a) We rated down the certainty of evidence due to very 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: 1 RCT(s) (N=25); Number of comparison(s) informing the indirect estimate: 2 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 2 months in the studies directly comparing the self-management intervention versus usual care.
13) a) We rated down the certainty of evidence due to very serious risk of bias and very serious inconsistency, and serious imprecision;b) Number of studies included in the network: 8 RCTs; Number of studies directly comparing the intervention with usual care: 7 RCT(s) (N=131); Number of comparison(s) informing the indirect estimate: 2 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 2 - 12 mo months in the studies directly comparing the self-management intervention versus usual care.
14) We rated down the certainty of evidence due to very serious risk of bias and serious inconsistency
References of studies informing direct evidence:
2) Barakat-2008Ghanem-2010
3) Sanchez-Nieto-2016
4) Martinez Iban-2018, Sanchez-Nieto-2016
5) Xi-2015
6) De Sousa Pinto-2014
7) Barakat-2008De Sousa Pinto-2014Ghanem-2010Xi-2015
8) Guell-2006Orme-2018
9) Guell-2006Orme-2018
10) Ghanem-2010, Xi-2015
11) Coultas-2016
12) Ghanem-2010
13) Carr-2009,De Sousa Pinto-2014,Gallefoss-2000,Guell-2006,Ho-2012,Orme-2018,Xi-2015
14) Carr-2009, De Sousa Pinto-2014,Ghanem-2010, Guell-2006, Ho-2012, Xi-2015
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