| 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 |
| 1.24725657947024 [0.7884, 1.7061] |
Low |
It may result in a large increase in activities of daily life |
1 |
88 |
1.24725657947024 [0.7884, 1.7061] |
N/A |
N/A |
N/A |
N/A |
| 2. 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 |
| 0.03 [-0.09, 0.14] |
Low |
It may result in little to no difference in FEV1 |
2 |
215 |
0.03 [-0.09, 0.14] |
Moderate |
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 |
| -18.28539 [-31.7292, 14.434319999999998] |
Low |
It may result in little to no difference in all cause admission |
1 |
6221 |
-0.59 [-1.48, 0.3] |
Low |
0.0 |
N/A |
NA |
| 4. 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 |
| -7.01358452426715 [-8.117160000000002, -5.809920000000002] |
Low |
It may results in a slight decrease smoking cessation |
1 |
6221 |
0.656196837045728 [0.6021, 0.7152] |
Low |
N/A |
N/A |
N/A |
| 5. 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 |
| -33.034147790000006 [-39.608310700000004, -24.16165286] |
Low |
It may result in little to no difference in COPD-related hospital admissions |
3 |
320 |
-0.84 [-1.14, -0.53] |
Low |
N/A |
NA [NA, NA] |
NA |
| 6. 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 |
| -0.12 [-0.46, 0.22] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
2 |
220 |
-0.1 [-0.45, 0.25] |
Very low |
1.0 |
-0.43 [-1.74, 0.88] |
Very low |
| 7. 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 |
| -31.151491799999995 [-36.964827899999996, -18.068364600000002] |
Moderate |
It likely results in little to no difference on exacerbations |
1 |
88 |
-1.38 [-2.19, -0.57] |
Moderate |
0.0 |
N/A |
NA |
| 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 |
| 0.7058 [0.4751, 1.0484] |
Low |
It may have little to no effect in emergency room admission |
2 |
6354 |
-0.35 [-0.74, 0.05] |
Moderate |
1.0 |
N/A |
NA |
| 9. 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 |
| -3.13 [-3.62, -2.59] |
Low |
It may result in little to no difference in mortality (all cause) |
1 |
8217 |
-0.48 [-0.58, -0.38] |
Low |
0.0 |
N/A |
NA |
| 10. 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 |
| 1.2 [-1.22, 3.61] |
Very low |
It may increase self-efficacy but the evidence is very uncertain |
1 |
88 |
1.22 [-1.62, 4.06] |
Low |
2.0 |
1.13 [-3.47, 5.73] |
Low |
| 11. 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 |
| -0.43 [-1.32, 0.46] |
Very low |
It may have little to no effect on dysnea but the evidence is very uncertain |
2 |
124 |
-0.5 [-1.52, 0.52] |
Very low |
1.0 |
-0.21 [-2.02, 1.61] |
Very low |
| 12. 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 [-0.45, 0.08] |
Low |
It may result in little to no difference in anxiety |
2 |
220 |
-0.18 [-0.45, 0.08] |
Low |
N/A |
N/A |
NA |
| 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 |
| -0.16 [-0.61, 0.3] |
Very low |
It may have little to no effect on quality of life (specific-disease instruments) but the evidence is very uncertain |
6 |
782 |
-0.18 [-0.67, 0.31] |
Very low |
8.0 |
-0.02 [-1.21, 1.18] |
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 |
| 0.47 [-0.29, 1.23] |
Very low |
It may have little to no effect on exercise capacity but the evidence is very uncertain |
4 |
544 |
0.47 [-0.29, 1.23] |
Very low |
0 |
N/A |
NA |
| 15. 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 |
| 0.05 [-0.03, 0.13] |
Low |
It may result in little to no difference in FEV1/FVC |
1 |
88 |
0.05 [-0.03, 0.13] |
Low |
0.0 |
N/A |
NA |
| 16. 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 |
| 0.6 [0.1, 1.1] |
Low |
It may result in little to no difference in FEV1 (% pred) |
1 |
6221 |
0.6 [0.1, 1.1] |
Low |
0.0 |
N/A |
NA |
Footnotes per outcome:
1) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 88); 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 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=105); 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.
3) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=3418); 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 -9 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
4) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 6221); b)We rated down the certainty of evidence due to very serious risk of bias and serious imprecision
5) a) We rated down the certainty of evidence due to very serious risk of bias;b) Number of studies included in the network: 21 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=159); 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 - 24 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;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=107); 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 3-24 months in the studies directly comparing the self-management intervention versus usual care.
7) 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: 1 RCT(s) (N=46); 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.
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: 15 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=4197); 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 48 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 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=42); 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 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,very serious inconsistency, ,,serious imprecision;b) Number of studies included in the network: 48 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=59); 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.
12) 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: 2 RCT(s) (N=107); 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 -24 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: 6 RCT(s) (N=387); 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 - 24 mo 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; b) Number of studies included in the network: 18 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=42); 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.
16) 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=3418); 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 48 months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
1) Wang-2014b
2) Jarab-2012a, Wang-2014b
3) Lou-2015
4) Lou-2015
5) Jarab-2012a, Wei-2014
6) Lamers-2010Titova-2017
7) Wang-2014b
8) Jarab-2012a, Lou-2015
9) Lou-2015
10) Wang-2014b
11) Gottlieb-2011Wang-2014b
12) Lamers-2010Titova-2017
13) Altenburg-2015,Demeyer-2017,Gottlieb-2011,Lamers-2010,Titova-2017,Wei-2014
14) Altenburg-2015, Demeyer-2017,Gottlieb-2011, Wang-2014b
15) Wang-2014b
16) Lou-2015
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