1. 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 |
0.7 [-0.04, 1.44] |
Very low |
It may increase quality of life (generic instruments) but the evidence is very uncertain |
1 |
516 |
0.07 [-0.94, 1.08] |
Low |
2.0 |
1.44 [0.35, 2.52] |
Low |
2. 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 |
2.871111111111113 [-10.32648, 33.364200000000004] |
Very low |
It may have little to no effect on smoking cessation but the evidence is very uncertain |
1 |
130 |
1.1407407407407408 [0.4938, 2.6355] |
Very low |
N/A |
N/A |
N/A |
3. 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 |
-18.850688999999996 [-28.9335189, -0.744872700000001] |
Low |
It may result in little to no difference in exacerbations |
1 |
100 |
-0.72 [-1.35, -0.1] |
Low |
1.0 |
0.23 [-1.43, 1.89] |
Low |
4. 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 |
-0.07 [-0.15, 0.01] |
Low |
It may result in little to no difference in FEV1/FVC |
1 |
20 |
-0.07 [-0.15, 0.01] |
Low |
0.0 |
N/A |
NA |
5. 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 |
-1.47 [-2.36, -0.58] |
Low |
It may result in a large decrease in dysnea |
1 |
97 |
-1.65 [-3.05, -0.25] |
Low |
3.0 |
-1.34 [-2.5, -0.19] |
Low |
6. 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 |
-38.89081111 [-56.309134490000005, 128.59575984999998] |
Very low |
It may have little to no effect on COPD-related hospital admissions but the evidence is very uncertain |
1 |
38 |
-1.1 [-3.36, 1.16] |
Low |
N/A |
NA [NA, NA] |
NA |
7. 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 [-1.25, -0.07] |
Very low |
It may increase quality of life (specific-disease instruments) but the evidence is very uncertain |
3 |
576 |
-0.16 [-0.89, 0.58] |
Very low |
9.0 |
-1.6 [-2.6, -0.6] |
Very low |
8. 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 |
0.3333 [0.0333, 3.3368] |
Low |
It may have little to no effect in emergency room admission |
1 |
38 |
-1.1 [-3.4, 1.21] |
Low |
0.0 |
N/A |
NA |
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 |
0.11 [-0.38, 0.6] |
Low |
It may result in little to no difference in FEV1 (% pred) |
1 |
20 |
0.11 [-0.38, 0.6] |
Low |
0.0 |
N/A |
NA |
10. 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 |
-0.18 [-0.35, -0.01] |
Low |
It may result in little to no difference in anxiety |
1 |
522 |
-0.18 [-0.35, -0.01] |
Low |
N/A |
N/A |
NA |
11. 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 |
1.14 [0.29, 1.98] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
2 |
117 |
1.0 [-0.14, 2.14] |
Low |
0 |
1.31 [0.05, 2.57] |
Low |
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 |
-0.13 [-0.5, 0.23] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
1 |
523 |
-0.13 [-0.5, 0.23] |
Low |
0.0 |
N/A |
NA |
13. 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 |
0.17 [-2.64, 2.98] |
Very low |
It may result in little to no difference in self-efficacy but the evidence is very uncertain |
1 |
522 |
0.17 [-2.64, 2.98] |
Low |
1.0 |
N/A |
NA |
Footnotes per outcome:
1) a) We rated down the certainty of evidence due to very 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: 1 RCT(s) (N=244); 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 months in the studies directly comparing the self-management intervention versus usual care. 2) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 130); b)We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision 3) 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=50); 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 14 months in the studies directly comparing the self-management intervention versus usual care. 4) 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=10); 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 6 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 of risk of bias, ;b) Number of studies included in the network: 48 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=47); 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 14 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 and serious imprecision;b) Number of studies included in the network: 21 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=19); 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 3 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 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: 3 RCT(s) (N=279); 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 -14 mo months in the studies directly comparing the self-management intervention versus usual care. 8) We rated down the certainty of the evidence due to very serious risk of bias 9) a) We rated down the certainty of evidence due to very serious risk of bias;b) Number of studies included in the network: 32 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=10); 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 6 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 of bias; b) Number of studies included in the network: 25 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=243); 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 months in the studies directly comparing the self-management intervention versus usual care. 11) We rated down the certainty of evidence due to serious imprecision and serious risk of bias 12) a) We rated down the certainty of evidence due to very serious risk of bias and serious incoherence;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=244); 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 6 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 serious 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=247); 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.
References of studies informing direct evidence:
1) Jolly-2018 2) Jolly-2018 3) Vasilopoulou-2017 4) Du Moulin-2009 5) Vasilopoulou-2017 6) Koff-2009 7) Du Moulin-2009,Jolly-2018,Vasilopoulou-2017 8) Koff-2009 9) Du Moulin-2009 10) Jolly-2018 11) Du Moulin-2009, Vasilopoulou-2017 12) Jolly-2018 13) Jolly-2018
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