| 1. 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 |
| 1.63184892570139 [0.9066, 2.3571] |
Low |
It may result in a large increase in activities of daily life |
1 |
40 |
1.63184892570139 [0.9066, 2.3571] |
N/A |
N/A |
N/A |
N/A |
| 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 |
| -0.13 [-0.4, 0.14] |
Very low |
It may have little to no effect on FEV1 (% pred) but the evidence is very uncertain |
5 |
206 |
0.09 [-0.19, 0.38] |
Very low |
2.0 |
-2.27 [-3.13, -1.41] |
Very 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 |
| 0.4588 [0.2604, 0.8084] |
Low |
It may have little to no effect in emergency room admission |
1 |
59 |
-1.01 [-1.68, -0.35] |
Low |
1.0 |
-0.17 [-1.24, 0.91] |
Low |
| 4. 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 |
| 0.08 [-0.02, 0.17] |
Very low |
It may have little to no effect on FEV1 but the evidence is very uncertain |
3 |
129 |
0.06 [-0.03, 0.16] |
Low |
2.0 |
0.22 [-0.1, 0.54] |
Low |
| 5. 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 |
| -14.3398398 [-23.577925799999996, -0.3745170000000003] |
Moderate |
It likely results in little to no difference on exacerbations |
3 |
388 |
-0.42 [-0.84, -0.01] |
Moderate |
0.0 |
N/A |
NA |
| 6. 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 |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| 1.85 [-2.18, 8.57] |
Low |
It may result in little to no difference in mortality (all cause) |
2 |
523 |
0.22 [-0.31, 0.74] |
Low |
1.0 |
-0.12 [-2.59, 2.35] |
Low |
| 7. 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 |
| 0.49 [0.05, 0.93] |
Very low |
It may have little to no effect on quality of life (generic instruments) but the evidence is very uncertain |
6 |
500 |
0.6 [0.13, 1.06] |
Very low |
4.0 |
-0.23 [-1.45, 0.99] |
Very low |
| 8. 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 |
| -0.78 [-1.31, -0.25] |
Very low |
It may decrease dysnea but the evidence is very uncertain |
4 |
160 |
-0.63 [-1.47, 0.22] |
Very low |
5.0 |
-0.88 [-1.56, -0.19] |
Low |
| 9. 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 |
| -0.19 [-0.4, 0.01] |
Low |
It may result in little to no difference in anxiety |
3 |
353 |
-0.19 [-0.4, 0.02] |
Low |
N/A |
-1.3 [-4.54, 1.94] |
NA |
| 10. 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 |
| -0.66 [-1.02, -0.29] |
Very low |
It may increase quality of life (specific-disease instruments) but the evidence is very uncertain |
8 |
716 |
-0.87 [-1.33, -0.4] |
Very low |
13.0 |
-0.33 [-0.91, 0.24] |
Very low |
| 11. 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 |
| 0.08 [0.06, 0.1] |
Low |
It may result in little to no difference in FEV1/FVC |
4 |
167 |
0.08 [0.06, 0.1] |
Low |
1.0 |
N/A |
NA |
| 12. 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 |
| -0.22 [-0.52, 0.09] |
Low |
It may result in little to no difference in depression |
3 |
353 |
-0.21 [-0.51, 0.1] |
Moderate |
2.0 |
-1.07 [-4.04, 1.89] |
Moderate |
| 13. 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 |
| -27.019139999999997 [-34.67196, -10.254450000000002] |
Low |
It may result in little to no difference in all cause admission |
2 |
286 |
-1.07 [-1.86, -0.29] |
Low |
1.0 |
N/A |
NA |
| 14. Smoking Cessation / Smoking cessation |
| 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 |
| 7.515360000000002 [-0.5508000000000005, 18.42732] |
Very low |
It may have a small effect on smoking cessation but the evidence is very uncertain |
1 |
227 |
1.3684 [0.973, 1.9033] |
Very low |
N/A |
N/A |
N/A |
| 15. 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 |
| 0.81 [0.32, 1.3] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
7 |
266 |
0.52 [-0.09, 1.13] |
Low |
0 |
1.35 [0.51, 2.18] |
Low |
Footnotes per outcome:
1) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 40); b)We rated down the certainty of evidence due to very serious risk of bias
2) a) We rated down the certainty of evidence due to very serious risk of bias,serious inconsistency, and serious incoherence;b) Number of studies included in the network: 32 RCTs; Number of studies directly comparing the intervention with usual care: 5 RCT(s) (N=117); 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 3 - 12 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 very 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: 3 RCT(s) (N=73); 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 3- 6 mo months in the studies directly comparing the self-management intervention versus usual care.
5) a) We rated down the certainty of evidence due to serious risk of bias;b) Number of studies included in the network: 15 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=196); 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.
6) 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: 2 RCT(s) (N=261); 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 7 - 12 mo months in the studies directly comparing the self-management intervention versus usual care.
7) a) We rated down the certainty of evidence due to very serious risk of bias, serious inconsistency and serious imprecision; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 6 RCT(s) (N=257); 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 1 - 12 mo 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 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=92); Number of comparison(s) informing the indirect estimate: 5 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.
9) a) We rated down the certainty of evidence due to serious of bias and serious inconsistency; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=178); 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 6 - 12 months in the studies directly comparing the self-management intervention versus usual care.
10) a) We rated down the certainty of evidence due to and serious imprecision;b) Number of studies included in the network: 8 RCTs; Number of studies directly comparing the intervention with usual care: 8 RCT(s) (N=374); Number of comparison(s) informing the indirect estimate: 6 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 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 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: 4 RCT(s) (N=97); 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 3 - 12 mo months in the studies directly comparing the self-management intervention versus usual care.
12) 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: 3 RCT(s) (N=178); 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 6-12 months in the studies directly comparing the self-management intervention versus usual care.
13) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=143); 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 1 - 12 months in the studies directly comparing the self-management intervention versus usual care.; b) We rated down the certainty of evidence due to very serious risk of bias
14) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 227); b)We rated down the certainty of evidence due to very serious risk of bias and serious imprecision
15) We rated down the certainty of evidence due to serious imprecision and very serious risk of bias
References of studies informing direct evidence:
1) Mohammadi-2013
2) Fernandez-2009Li-2018bLin-2012aNiu-2014Wu-2018a
3) Segrelles Calvo-2014
4) Lin-2012a, Niu-2014, Wu-2018a
5) Xin-2016; Li-2015; Mcdowell-2015
6) Bucknall-2012, Segrelles Calvo-2014
7) Chuang-2017, Mcdowell-2015, Mohammadi-2013, Murphy-2005, Nield-2007,Soriano-2018
8) Chuang-2017Fernandez-2009Murphy-2005Nield-2007
9) Mcdowell-2015Orme-2018Soriano-2018
10) Fernandez-2009,Mcdowell-2015,Murphy-2005,Orme-2018,Petersen-2008,Soriano-2018,Wu-2018a,Xin-2016
11) Fernandez-2009Li-2018bLin-2012aWu-2018a
12) Mcdowell-2015Orme-2018Soriano-2018
13) Segrelles Calvo-2014, Xin-2016
14) Xin-2016
15) Chuang-2017, Fernandez-2009,Murphy-2005, Nield-2007, Niu-2014, Petersen-2008, Wu-2018a
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