Home care by outreach nursing for chronic obstructive pulmonary disease

Christopher X Wong; Kristin V Carson; Brian J Smith

doi:10.1002/14651858.CD000994.pub3

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Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 3

Forest plot of comparison: 1 Respiratory outreach nurse vs control, outcome: 1.3 Change in SGRQ Total Score.

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Figure 4

Forest plot of comparison: 1 Respiratory outreach nurse vs control, outcome: 1.9 Mortality.

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Figure 5

Forest plot of comparison: 1 Respiratory outreach nurse vs control, outcome: 1.10 Hospitalisation.

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Analysis 1.1

Comparison 1 Respiratory outreach nurse vs control, Outcome 1 Change in SGRQ Total Score.

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Analysis 1.2

Comparison 1 Respiratory outreach nurse vs control, Outcome 2 Mortality.

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Analysis 1.3

Comparison 1 Respiratory outreach nurse vs control, Outcome 3 Hospitalisation.

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Analysis 1.4

Comparison 1 Respiratory outreach nurse vs control, Outcome 4 Family doctor visits.

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Analysis 1.5

Comparison 1 Respiratory outreach nurse vs control, Outcome 5 Change in SGRQ Activity Sub‐score.

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Analysis 1.6

Comparison 1 Respiratory outreach nurse vs control, Outcome 6 Change in SGRQ Impact Sub‐score.

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Analysis 1.7

Comparison 1 Respiratory outreach nurse vs control, Outcome 7 Change in SGRQ Symptoms Sub‐score.

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Analysis 1.8

Comparison 1 Respiratory outreach nurse vs control, Outcome 8 Change in SIP scores (generic HRQL).

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Analysis 1.9

Comparison 1 Respiratory outreach nurse vs control, Outcome 9 FEV1 % Change.

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Analysis 1.10

Comparison 1 Respiratory outreach nurse vs control, Outcome 10 Six minute walk distance, change (m).

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Summary of findings for the main comparison. Home care outreach nursing for patients with COPD

Home care outreach nursing for patients with COPD
Patient or population: patients with COPD Settings: Intervention: home care outreach nursing
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Home care outreach nursing
Mortality Follow‐up: 4‐12 months	Study population		OR 0.72 (0.45 to 1.15)	711 (5 studies)	⊕⊕⊝⊝ low^1,2	¹ Subjects not blinded due to the nature of the intervention ² Wide confidence intervals that include the possibility of significant benefit or harm
	127 per 1000	95 per 1000 (61 to 143)
SGRQ Total SGRQ (Total) Score. Scale from: 0 to 100. Lower score indicates better quality of life. Follow‐up: 3‐12 months	The mean SGRQ total in the control groups was ‐ 0.1 units	The mean SGRQ total in the intervention groups was 2.60 units lower (4.81 to 0.39 lower)		587 (4 studies)	⊕⊕⊝⊝ low^1,2	¹ Subjects not blinded due to the nature of the intervention ² Wide confidence intervals
Hospitalisation Follow‐up: 3‐12 months	Study population		OR 1.01 (0.71 to 1.44)	686 (5 studies)	⊕⊕⊝⊝ low^1,2	¹ Subjects not blinded due to the nature of the intervention ² Wide confidence intervals that include the possibility of significant benefit or harm
	480 per 1000	482 per 1000 (396 to 571)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio;
GRADE Working Group grades of evidence 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.
¹ Subjects not blinded due to the nature of the intervention ² Wide confidence intervals that include the possibility of significant benefit or harm

Summary of findings for the main comparison. Home care outreach nursing for patients with COPD

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Table 1. Baseline lung function (FEV1 %predicted) and inclusion criteria related to exacerbation frequency

Study	Baseline FEV1 %predicted	Exacerbation frequency
Aiken 2006	Not reported	Patients had recent exacerbations as evidenced by treatment in an emergency department, urgent care facility, or hospital within the 3 months prior to enrolment. Participants averaged 0.12 emergency department visits per month (SD 0.18) in the previous 6 months. Control participants averaged 0.11 ED visits per month (SD 0.20).
Bergner 1988	34%	FEV1 <60% predicted Average 11.7 hospital days in previous year
Bourbeau 2003	FEV1 1 L	stable COPD (respiratory symptoms and medication unchanged for at least 4 weeks before enrolment) FEV1 after the use of a bronchodilator between 25% and 70% of the predicted normal value There were approx 1.6 acute exacerbation visits per person in the year previous to study entry
Cockcroft 1987	FEV1 0.8 L	Patients who had been admitted to hospital at least twice during the previous three years and new patients who had been seen during the past year were eligible
Coultas 2005	40% patients stage IIA (≥50<80%) 44% IIB (≥30<50%) 16% III (<30%)	FEV1< 80% predicted
Hermiz 2002	Not reported
Kwok 2004	Intervention PEF 155 L/min Control PEF 51 L/min
Littlejohns 1991	Intervention 45.2% (22 4) Control 50.2% (23‐0)	FEVI < 60% predicted Partcipants were in a stable state as judged by the patient and physician with no change or perceived need for change in medication for at least six weeks before recruitment.
Smith 1999	33%	Patients required to have a FEV1/FVC ratio of less than 60%, no other active major illnesses at time of entry into study and, be in a stable state.

Table 1. Baseline lung function (FEV1 %predicted) and inclusion criteria related to exacerbation frequency

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Comparison 1. Respiratory outreach nurse vs control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in SGRQ Total Score Show forest plot	4	587	Mean Difference (IV, Fixed, 95% CI)	‐2.60 [‐4.81, ‐0.39]

2 Mortality Show forest plot	5	711	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.72 [0.45, 1.15]

3 Hospitalisation Show forest plot	5	686	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.01 [0.71, 1.44]

4 Family doctor visits Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

5 Change in SGRQ Activity Sub‐score Show forest plot	3	455	Mean Difference (IV, Fixed, 95% CI)	‐1.32 [‐4.46, 1.82]

6 Change in SGRQ Impact Sub‐score Show forest plot	3	455	Mean Difference (IV, Fixed, 95% CI)	‐2.63 [‐5.77, 0.50]

7 Change in SGRQ Symptoms Sub‐score Show forest plot	3	429	Mean Difference (IV, Fixed, 95% CI)	‐1.15 [‐4.70, 2.41]

8 Change in SIP scores (generic HRQL) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

8.1 total	2		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 physical	2		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 psychosocial	2		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 FEV1 % Change Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

10 Six minute walk distance, change (m) Show forest plot	2	272	Mean Difference (IV, Fixed, 95% CI)	5.05 [‐15.08, 25.18]

Comparison 1. Respiratory outreach nurse vs control

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