Summary of findings
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk (control) | Corresponding risk (disease management) | |||||
| Disease specific quality of life on the SGRQ, total score (follow-up: 3–12 months) | The mean change in the SGRQ (total score) ranged from 3.4 lower to 6.24 higher | The mean SGRQ in the intervention groups was 3.71 lower (5.83 to 1.59 lower). | MD −3.71 (−5.83 to −1.59) | 1425 (13 studies) | High† | Minimal clinically important difference (MCID)=−4 points, lower score means improvement |
| Disease specific quality of life on the CRQ dyspnoea domain (follow-up: 3–12 months) | The mean change in the CRQ (dyspnoea domain) ranged from 0 to 0.2 lower | The mean CRQ dyspnoea domain in the intervention groups was 1.02 higher (0.67 to 1.36 higher) | MD 1.02 (0.68 to 1.36) | 160 (4 studies) | Moderate‡ | MCID=0.5 points. Results on the other domains of the CRQ (fatigue, emotion, mastery) were also all statistically and clinically relevant. |
| Functional exercise capacity (6 min walking distance (6MWD)) (follow-up: 3–12 months) | The mean change in the 6MWD ranged from 38 lower to 36 higher | The mean functional exercise capacity in the intervention groups was 43.86 higher (21.83 to 65.89 higher) | MD 43.86 (21.83 to 65.89) | 838 (14 studies) | Moderate§ | MCID=35 m. Sensitivity analysis showed there was inconsistency in the effect. After removing the low quality studies, the MD was 15.15 m (95% CI 6.37 to 23.93, p<0.001). |
| Respiratory related hospital admissions (follow-up: 3–12 months) | 27 per 100 patients | 20 per 100 patients (15 to 27) | OR 0.68 (0.47 to 0.99) | 1470 (7 studies) | High | |
| Number of hospital days per patient (all causes) (follow-up: 3–12 months) | The mean change in hospital days ranged from 1.6 to 11.9 higher | The mean number of hospital days per patient in the intervention groups was 3.78 lower (5.9 to 1.67 lower) | MD −3.78 (−5.9 to −1.67) | 741 (6 studies) | High | |
This table is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews 20131 (see http://www.thecochranelibrary.com for information).
Disease management compared to control for patients with COPD. Patient or population = patients with COPD. Settings: 8 studies in primary care, 12 studies in secondary care, 1 study in tertiary care, 5 studies each in primary and secondary care. Intervention: integrated disease management. Comparison: control (usual care).
GRADE Working Group grades of evidence are as follows. High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
*The basis for the assumed risk (eg, the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
†We did not downgrade due to risk of bias, as studies contributing more than 2.7% to the meta-analysis had a low risk of bias. Sensitivity analysis on high-risk studies did not change the effect or significance of the effect.
‡We downgraded by one as there was considerable risk of bias in two studies on allocation concealment and two studies did not blind the outcome assessor.
§We downgraded by one as all included studies were of moderate to low quality. If we removed studies that scored high or unclear risk of bias on allocation concealment, the effect decreased to 15 m.
MD, mean difference; CRQ, chronic respiratory questionnaire; SGRQ, St George Respiratory Questionnaire.