| 1. 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 |
| -17.114990219999996 [-30.939982319999995, 3.6924978899999945] |
Moderate |
It likely results in little to no difference on COPD-related hospital admissions |
2 |
399 |
-0.29 [-0.74, 0.17] |
Moderate |
1.0 |
-0.62 [-1.56, 0.33] |
Low |
| 2. 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 |
| 0.662 [0.4396, 0.9969] |
Low |
It may have little to no effect in emergency room admission |
3 |
635 |
-0.41 [-0.82, 0.0] |
Low |
0.0 |
N/A |
NA |
| 3. 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 |
| -9.140640000000001 [-25.70394, 25.231289999999994] |
Very low |
It may have little to no effect in all cause admission but the evidence is very uncertain |
2 |
327 |
-0.25 [-0.98, 0.48] |
Very low |
1.0 |
N/A |
NA |
| 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 |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
Number of comparisons informing indirect evidence |
Relative effects (95% CI) - Difference |
Certainty of the evidence |
| 4.56 [-0.06, 11.81] |
Low |
It may result in a slight increase in mortality (all cause) |
1 |
389 |
0.44 [-0.01, 0.89] |
Moderate |
N/A |
N/A |
NA |
| 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 |
| -7.8398892 [-23.6195388, 21.776082900000002] |
Low |
It may result in little to no difference in exacerbations |
1 |
158 |
-0.21 [-0.84, 0.42] |
Low |
0.0 |
N/A |
NA |
| 6. 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 |
| 0.32 [-0.34, 0.98] |
Very low |
It may have little to no effect on quality of life (generic instruments) but the evidence is very uncertain |
2 |
276 |
0.43 [-0.32, 1.18] |
Very low |
1.0 |
-0.09 [-1.51, 1.33] |
Low |
| 7. 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 |
| 0.07 [-0.09, 0.24] |
Very low |
It may have little to no effect on FEV1 but the evidence is very uncertain |
1 |
143 |
0.14 [-0.08, 0.36] |
Low |
1.0 |
-0.02 [-0.27, 0.24] |
Low |
| 8. 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 |
| -1.1439999999999992 [-8.667960000000003, 11.203679999999999] |
Very low |
It may have little to no effect on smoking cessation but the evidence is very uncertain |
1 |
158 |
0.943921568627451 [0.5751, 1.5492] |
Very low |
N/A |
N/A |
N/A |
| 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 |
| -0.37 [-0.6, -0.13] |
Very low |
It may have little to no effect on anxiety but the evidence is very uncertain |
2 |
276 |
-0.37 [-0.6, -0.13] |
Low |
N/A |
N/A |
NA |
| 10. 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 |
| -0.48 [-0.81, -0.16] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
2 |
276 |
-0.5 [-0.84, -0.17] |
Very low |
3.0 |
-0.18 [-1.49, 1.14] |
Very low |
| 11. Self-efficacy |
| 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 |
| 1.18 [-0.68, 3.05] |
Very low |
It may increase self-efficacy but the evidence is very uncertain |
2 |
244 |
1.17 [-0.84, 3.18] |
Very low |
3.0 |
1.26 [-3.76, 6.28] |
Very low |
| 12. 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 |
| -1.65 [-5.57, 2.28] |
Very low |
It may have little to no effect on FEV1 (% pred) but the evidence is very uncertain |
1 |
158 |
-4.0 [-10.41, 2.41] |
Low |
1.0 |
-0.24 [-5.2, 4.72] |
Low |
| 13. 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 |
| -0.19 [-0.82, 0.44] |
Very low |
It may have little to no effect on dysnea but the evidence is very uncertain |
4 |
600 |
-0.13 [-0.81, 0.56] |
Low |
2.0 |
-0.6 [-2.3, 1.11] |
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 |
| 0.68 [-0.06, 1.42] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
3 |
434 |
0.4 [-0.46, 1.26] |
Very low |
0 |
1.44 [0.02, 2.86] |
Low |
| 15. 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 |
| -0.28 [-0.76, 0.2] |
Very low |
It may increase quality of life (specific-disease instruments) but the evidence is very uncertain |
5 |
768 |
-0.27 [-0.8, 0.26] |
Very low |
27.0 |
-0.34 [-1.42, 0.74] |
Low |
Footnotes per outcome:
1) 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=197); 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 -12 months in the studies directly comparing the self-management intervention versus usual care.
2) We rated down the certainty of the evidence due to very serious risk of bias
3) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=160); 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 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 and to serious inconsistency
4) 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: 15 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=196); 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 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: 15 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=83); 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.
6) 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: 2 RCT(s) (N=140); 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 - 3 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 imprecision;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=71); 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.
8) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 158); b)We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision
9) 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: 25 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=140); 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 1-3 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,serious inconsistency 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=140); Number of comparison(s) informing the indirect estimate: 3 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 1-3 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, 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: 2 RCT(s) (N=118); Number of comparison(s) informing the indirect estimate: 3 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 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 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=75); 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 9 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, , ,,serious imprecision;b) Number of studies included in the network: 48 RCTs; Number of studies directly comparing the intervention with usual care: 4 RCT(s) (N=305); 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 - 9 months in the studies directly comparing the self-management intervention versus usual care.
14) We rated down the certainty of evidence due to serious imprecision, very serious risk of bias, and serious inconsistency
15) 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: 5 RCT(s) (N=380); 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 mo months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
1) Benzo-2016, Mitchell-2014
2) Collinsworth-2018, Khdour-2011, Mitchell-2014
3) Khdour-2011, Mitchell-2014
4) Greening-2014
5) Thom-2018
6) Eaton-2009, Griffiths-2001
7) Khdour-2011
8) Thom-2018
9) Eaton-2009Griffiths-2001
10) Eaton-2009Griffiths-2001
11) Thom-2018,Wang-2017b
12) Thom-2018
13) Eaton-2009Renn-2018Thom-2018Weldam-2017
14) Eaton-2009, Griffiths-2001,Thom-2018
15) Eaton-2009,Griffiths-2001,Khdour-2011,Thom-2018,Weldam-2017
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