| 1. 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 |
| -14.1692265 [-23.432280299999995, -0.191419800000002] |
Low |
It may result in little to no difference in exacerbations |
3 |
344 |
-0.42 [-0.83, 0.0] |
Low |
0.0 |
N/A |
NA |
| 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 |
| 15.585600000000001 [-0.4304400000000002, 44.49036] |
Very low |
It may have a small effect on smoking cessation but the evidence is very uncertain |
2 |
402 |
1.764 [0.9789, 3.1809] |
Very low |
N/A |
N/A |
N/A |
| 3. 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 |
| -0.91 [-1.43, -0.39] |
Very low |
It may decrease dysnea but the evidence is very uncertain |
7 |
430 |
-0.92 [-1.47, -0.36] |
Very low |
2.0 |
-0.87 [-2.43, 0.7] |
Very low |
| 4. 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 |
| 1.07 [0.33, 1.8] |
Very low |
It may increase exercise capacity but the evidence is very uncertain |
4 |
199 |
1.12 [0.29, 1.95] |
Very low |
0 |
0.86 [-0.72, 2.45] |
Very low |
| 5. 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 |
| -0.13 [-0.57, 0.3] |
Very low |
It may decrease quality of life (specific-disease instruments) but the evidence is very uncertain |
8 |
1105 |
-0.02 [-0.48, 0.45] |
Very low |
10.0 |
-1.01 [-2.27, 0.26] |
Very 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 |
| -0.68 [-1.01, -0.35] |
Very low |
It may decrease anxiety but the evidence is very uncertain |
3 |
154 |
-0.68 [-1.01, -0.35] |
Low |
N/A |
N/A |
NA |
| 7. 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 |
| -0.5 [-0.86, -0.14] |
Very low |
It may have little to no effect on depression but the evidence is very uncertain |
4 |
164 |
-0.5 [-0.86, -0.14] |
Low |
0.0 |
N/A |
NA |
| 8. 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 |
| -15.059039999999998 [-28.60149, 13.156110000000002] |
Low |
It may result in little to no difference in all cause admission |
2 |
838 |
-0.46 [-1.19, 0.28] |
Low |
0.0 |
N/A |
NA |
| 9. 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 |
| -0.11 [-0.32, 0.1] |
Very low |
It may decrease FEV1 but the evidence is very uncertain |
1 |
104 |
-0.11 [-0.32, 0.1] |
Low |
0.0 |
N/A |
NA |
| 10. 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 |
| -4.1 [-6.66, 2.72] |
Moderate |
It likely results in a slight reduction in mortality (all cause) |
1 |
122 |
-0.69 [-1.67, 0.29] |
Moderate |
0.0 |
N/A |
NA |
| 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 |
| 0.14 [-0.03, 0.3] |
Low |
It may result in little to no difference in FEV1/FVC |
3 |
235 |
0.14 [-0.03, 0.3] |
Low |
0.0 |
N/A |
NA |
| 12. 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 |
| 1.5315 [0.9742, 2.4078] |
Low |
It may have little to no effect in emergency room admission |
2 |
1477 |
0.43 [-0.03, 0.88] |
Moderate |
0.0 |
N/A |
NA |
| 13. 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 |
| 0.48 [-0.3, 1.25] |
Very low |
It may result in little to no difference in quality of life (generic instruments) but the evidence is very uncertain |
2 |
729 |
0.48 [-0.3, 1.25] |
Low |
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 |
| 0.62 [-1.37, 2.61] |
Low |
It may result in little to no difference in FEV1 (% pred) |
3 |
329 |
0.62 [-1.37, 2.61] |
Low |
0.0 |
N/A |
NA |
| 15. 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 |
| 1.08 [-0.62, 2.77] |
Very low |
It may increase self-efficacy but the evidence is very uncertain |
3 |
117 |
1.08 [-0.62, 2.77] |
Very low |
1.0 |
N/A |
NA |
Footnotes per outcome:
1) 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: 3 RCT(s) (N=171); 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 6-24 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 (2 RCT, N= 402); b)We rated down the certainty of evidence due to very serious risk of bias and serious imprecision
3) 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: 48 RCTs; Number of studies directly comparing the intervention with usual care: 7 RCT(s) (N=226); 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 1 - 24 months in the studies directly comparing the self-management intervention versus usual care.
4) We rated down the certainty of evidence due to serious imprecision, very serious risk of bias, and serious inconsistency
5) 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: 8 RCT(s) (N=566); 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 1 -24 mo 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: 25 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=81); 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- 6 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 serious imprecision;b) Number of studies included in the network: 30 RCTs; Number of studies directly comparing the intervention with usual care: 4 RCT(s) (N=86); 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 1-6 months in the studies directly comparing the self-management intervention versus usual care.
8) a) Number of studies included in the network: 19 RCTs; Number of studies directly comparing the intervention with usual care: 2 RCT(s) (N=426); 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 - 24 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 and serious inconsistency
9) a) We rated down the certainty of evidence due to very 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: 1 RCT(s) (N=55); 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 24 months in the studies directly comparing the self-management intervention versus usual care.
10) 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=61); 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 24 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: 3 RCT(s) (N=121); 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 2- 12 mo months in the studies directly comparing the self-management intervention versus usual care.
12) We rated down the certainty of the evidence due to very serious risk of bias
13) a) We rated down the certainty of evidence due to 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=366); 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- 6 mo 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;b) Number of studies included in the network: 32 RCTs; Number of studies directly comparing the intervention with usual care: 3 RCT(s) (N=171); 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 2 - 24 mo months in the studies directly comparing the self-management intervention versus usual care.
15) 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: 3 RCT(s) (N=62); 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 2 -6 mo months in the studies directly comparing the self-management intervention versus usual care.
References of studies informing direct evidence:
1) Sridhar-2008; Wang-2018c; Vasilopoulou-2017
2) Chen-2014, Van Boven-2014
3) Bove-2016Karapolat-2007Kayahan-2006Sridhar-2008Vasilopoulou-2017Yeh-2010Yilmaz-2017
4) Karapolat-2007, Kayahan-2006,Vasilopoulou-2017, Yeh-2010
5) Hynninen-2010,Karapolat-2007,Kayahan-2006,Sridhar-2008,Van Boven-2014,Vasilopoulou-2017,Weekes-2009,Yeh-2010
6) Bove-2016Hynninen-2010Kayahan-2006
7) Bove-2016Hynninen-2010Kayahan-2006Yeh-2010
8) Sridhar-2008, Van Boven-2014
9) Sridhar-2008
10) Sridhar-2008
11) Karapolat-2007Ko-2017Yeh-2010
12) Van Boven-2014, Rice-2010a
13) Van Boven-2014, Weekes-2009
14) Karapolat-2007Ko-2017Sridhar-2008
15) Khoshkesht-2015, Ng-2017, Yeh-2010
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