| 1. 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 |
| 0.14 [-0.06, 0.34] |
Very low |
It may increase FEV1 but the evidence is very uncertain |
0 |
0 |
[, ] |
N/A |
1.0 |
0.14 [-0.06, 0.34] |
Low |
| 2. 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 [-1.5, -0.06] |
Low |
It may result in a slight decrease in dysnea |
1 |
29 |
-0.24 [-1.75, 1.27] |
Low |
3.0 |
-0.94 [-1.76, -0.12] |
Low |
| 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 |
| -5.542851599999999 [-20.0949177, 18.850689] |
Low |
It may result in little to no difference in exacerbations |
2 |
446 |
-0.14 [-0.66, 0.37] |
Low |
0.0 |
N/A |
NA |
| 4. 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 |
| -5.441639999999999 [-24.281879999999997, 34.49934] |
Moderate |
It likely results in little to no difference in all cause admission |
2 |
338 |
-0.14 [-0.89, 0.61] |
Moderate |
0.0 |
N/A |
NA |
| 5. 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 |
| 0.56 [-0.1, 1.22] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
3 |
355 |
0.18 [-0.72, 1.07] |
Low |
0 |
1.02 [0.04, 1.99] |
Low |
| 6. 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 |
| 0.25 [0.01, 0.48] |
Moderate |
It likely results in little to no difference on anxiety |
1 |
280 |
0.25 [0.01, 0.48] |
Moderate |
N/A |
N/A |
NA |
| 7. 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 |
| -18.22915625 [-39.719143970000005, 28.08165062] |
Low |
It may result in little to no difference in COPD-related hospital admissions |
1 |
46 |
-0.37 [-1.14, 0.39] |
Low |
N/A |
NA [NA, NA] |
NA |
| 8. 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 |
| -0.38 [-0.85, 0.09] |
Very low |
It may increase quality of life (specific-disease instruments) but the evidence is very uncertain |
3 |
467 |
-0.2 [-0.9, 0.5] |
Very low |
10.0 |
-0.52 [-1.15, 0.11] |
Very 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 |
| -0.05 [-0.4, 0.31] |
Moderate |
It likely results in little to no difference on depression |
2 |
309 |
-0.05 [-0.4, 0.31] |
Moderate |
0.0 |
N/A |
NA |
| 10. 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 |
| -0.8827694728560178 [-7.050240000000001, 8.133480000000002] |
Very low |
It may have little to no effect on smoking cessation but the evidence is very uncertain |
1 |
141 |
0.956726986624705 [0.6544, 1.3987] |
Very low |
N/A |
N/A |
N/A |
| 11. 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 |
| -0.15 [-1.38, 1.09] |
Very low |
It may have little to no effect on quality of life (generic instruments) but the evidence is very uncertain |
1 |
29 |
-0.15 [-1.38, 1.09] |
Low |
0.0 |
N/A |
NA |
| 12. 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 |
| 0.01 [-0.06, 0.08] |
Low |
It may result in little to no difference in FEV1/FVC |
1 |
29 |
0.01 [-0.06, 0.08] |
Low |
0.0 |
N/A |
NA |
| 13. 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 |
| -1.94 [-6.43, 13.98] |
Low |
It may result in little to no difference in mortality (all cause) |
1 |
166 |
-0.27 [-1.53, 1.0] |
Moderate |
0.0 |
N/A |
NA |
| 14. 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 |
| 2.68 [-0.15, 5.5] |
Very low |
It may have little to no effect on FEV1 (% pred) but the evidence is very uncertain |
2 |
204 |
2.79 [-0.23, 5.81] |
Low |
1.0 |
1.87 [-6.24, 9.97] |
Low |
Footnotes per outcome:
1) a) We rated down the certainty of evidence due to risk of bias,,very serious imprecision;b) Number of studies included in the network: 30 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).
2) 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=14); 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 3 months in the studies directly comparing the self-management intervention versus usual care.
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: 2 RCT(s) (N=204); 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 12 months in the studies directly comparing the self-management intervention versus usual care.
4) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=203); 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.; b) We rated down the certainty of evidence due to serious risk of bias
5) We rated down the certainty of evidence due to serious imprecision and serious risk of bias
6) a) We rated down the certainty of evidence due to 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=132); 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.
7) 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: 1 RCT(s) (N=23); 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.
8) 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: 3 RCT(s) (N=248); 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 3- 12 mo 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 risk of bias, and ;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=146); 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.
10) a) This estimate is a result of a pairwise meta-analysis (1 RCT, N= 141); b)We rated down the certainty of evidence due to very serious risk of bias and very serious imprecision
11) a) We rated down the certainty of evidence due to very serious risk 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=14); 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 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; b) Number of studies included in the network: 18 RCTs; Number of studies directly comparing the intervention with usual care: 1 RCT(s) (N=14); 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 months in the studies directly comparing the self-management intervention versus usual care.
13) 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=110); 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 12 months in the studies directly comparing the self-management intervention versus usual care.
14) 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: 2 RCT(s) (N=101); 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 - 4 mo months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
2) Donesky-Cuenco-2009
3) Arbillaga-Etxarri-2018; Farmer-2017
4) Farmer-2017, Jennings-2015
5) Arbillaga-Etxarri-2018, Boxall-2005,Donesky-Cuenco-2009
6) Arbillaga-Etxarri-2018
7) Boxall-2005
8) Arbillaga-Etxarri-2018,Boxall-2005,Farmer-2017
9) Arbillaga-Etxarri-2018Donesky-Cuenco-2009
10) Farmer-2017
11) Donesky-Cuenco-2009
12) Donesky-Cuenco-2009
13) Farmer-2017
14) Donesky-Cuenco-2009Van Wetering-2010a
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