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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

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

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 2

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

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.3 Treatment at a hospital emergency department for COPD in 12 months.
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Figure 3

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.3 Treatment at a hospital emergency department for COPD in 12 months.

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.11 Courses of oral corticosteroids in 12 months.
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Figure 4

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.11 Courses of oral corticosteroids in 12 months.

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.16 Change in SGRQ overall score (impute SD Watson 1997).
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Figure 5

Forest plot of comparison: 1 Action Plan versus usual care, outcome: 1.16 Change in SGRQ overall score (impute SD Watson 1997).

Comparison 1 Action plan versus usual care, Outcome 1 Hospital admission (12 months).
Figuras y tablas -
Analysis 1.1

Comparison 1 Action plan versus usual care, Outcome 1 Hospital admission (12 months).

Comparison 1 Action plan versus usual care, Outcome 2 At least 1 hospital admission (12 months).
Figuras y tablas -
Analysis 1.2

Comparison 1 Action plan versus usual care, Outcome 2 At least 1 hospital admission (12 months).

Comparison 1 Action plan versus usual care, Outcome 3 Emergency department attendance for COPD (12 months).
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Analysis 1.3

Comparison 1 Action plan versus usual care, Outcome 3 Emergency department attendance for COPD (12 months).

Comparison 1 Action plan versus usual care, Outcome 4 At least 1 emergency department attendance (12 months).
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Analysis 1.4

Comparison 1 Action plan versus usual care, Outcome 4 At least 1 emergency department attendance (12 months).

Comparison 1 Action plan versus usual care, Outcome 5 Ambulance calls (total).
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Analysis 1.5

Comparison 1 Action plan versus usual care, Outcome 5 Ambulance calls (total).

Comparison 1 Action plan versus usual care, Outcome 6 GP visits/phone contacts for COPD (all or urgent).
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Analysis 1.6

Comparison 1 Action plan versus usual care, Outcome 6 GP visits/phone contacts for COPD (all or urgent).

Comparison 1 Action plan versus usual care, Outcome 7 GP visits/phone contacts (total or all non‐COPD).
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Analysis 1.7

Comparison 1 Action plan versus usual care, Outcome 7 GP visits/phone contacts (total or all non‐COPD).

Comparison 1 Action plan versus usual care, Outcome 8 At least one GP visit (12 months).
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Analysis 1.8

Comparison 1 Action plan versus usual care, Outcome 8 At least one GP visit (12 months).

Comparison 1 Action plan versus usual care, Outcome 9 Courses of oral corticosteroids (12 months).
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Analysis 1.9

Comparison 1 Action plan versus usual care, Outcome 9 Courses of oral corticosteroids (12 months).

Comparison 1 Action plan versus usual care, Outcome 10 Courses of antibiotics (12 months).
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Analysis 1.10

Comparison 1 Action plan versus usual care, Outcome 10 Courses of antibiotics (12 months).

Comparison 1 Action plan versus usual care, Outcome 11 At least 1 course antibiotics for exacerbation.
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Analysis 1.11

Comparison 1 Action plan versus usual care, Outcome 11 At least 1 course antibiotics for exacerbation.

Comparison 1 Action plan versus usual care, Outcome 12 At least 1 course oral steroids for exacerbation.
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Analysis 1.12

Comparison 1 Action plan versus usual care, Outcome 12 At least 1 course oral steroids for exacerbation.

Comparison 1 Action plan versus usual care, Outcome 13 Days on corticosteroids (6 months).
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Analysis 1.13

Comparison 1 Action plan versus usual care, Outcome 13 Days on corticosteroids (6 months).

Comparison 1 Action plan versus usual care, Outcome 14 Days on antibiotics (6 months).
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Analysis 1.14

Comparison 1 Action plan versus usual care, Outcome 14 Days on antibiotics (6 months).

Comparison 1 Action plan versus usual care, Outcome 15 At least 1 exacerbation of COPD in 6 months.
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Analysis 1.15

Comparison 1 Action plan versus usual care, Outcome 15 At least 1 exacerbation of COPD in 6 months.

Comparison 1 Action plan versus usual care, Outcome 16 SGRQ overall score.
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Analysis 1.16

Comparison 1 Action plan versus usual care, Outcome 16 SGRQ overall score.

Comparison 1 Action plan versus usual care, Outcome 17 SGRQ symptom score.
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Analysis 1.17

Comparison 1 Action plan versus usual care, Outcome 17 SGRQ symptom score.

Comparison 1 Action plan versus usual care, Outcome 18 SGRQ activity limitation score.
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Analysis 1.18

Comparison 1 Action plan versus usual care, Outcome 18 SGRQ activity limitation score.

Comparison 1 Action plan versus usual care, Outcome 19 SGRQ impact score.
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Analysis 1.19

Comparison 1 Action plan versus usual care, Outcome 19 SGRQ impact score.

Comparison 1 Action plan versus usual care, Outcome 20 SF36 physical function (6 months).
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Analysis 1.20

Comparison 1 Action plan versus usual care, Outcome 20 SF36 physical function (6 months).

Comparison 1 Action plan versus usual care, Outcome 21 SF36 role limitation physical (6 months).
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Analysis 1.21

Comparison 1 Action plan versus usual care, Outcome 21 SF36 role limitation physical (6 months).

Comparison 1 Action plan versus usual care, Outcome 22 SF36 bodily pain at 6 months.
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Analysis 1.22

Comparison 1 Action plan versus usual care, Outcome 22 SF36 bodily pain at 6 months.

Comparison 1 Action plan versus usual care, Outcome 23 SF36 general health (6 months).
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Analysis 1.23

Comparison 1 Action plan versus usual care, Outcome 23 SF36 general health (6 months).

Comparison 1 Action plan versus usual care, Outcome 24 SF36 vitality (6 months).
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Analysis 1.24

Comparison 1 Action plan versus usual care, Outcome 24 SF36 vitality (6 months).

Comparison 1 Action plan versus usual care, Outcome 25 SF36 social function (6 months).
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Analysis 1.25

Comparison 1 Action plan versus usual care, Outcome 25 SF36 social function (6 months).

Comparison 1 Action plan versus usual care, Outcome 26 SF36 role limitation emotional (6 months).
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Analysis 1.26

Comparison 1 Action plan versus usual care, Outcome 26 SF36 role limitation emotional (6 months).

Comparison 1 Action plan versus usual care, Outcome 27 SF36 general mental health (6 months).
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Analysis 1.27

Comparison 1 Action plan versus usual care, Outcome 27 SF36 general mental health (6 months).

Comparison 1 Action plan versus usual care, Outcome 28 HADS ‐ depression score (12 months).
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Analysis 1.28

Comparison 1 Action plan versus usual care, Outcome 28 HADS ‐ depression score (12 months).

Comparison 1 Action plan versus usual care, Outcome 29 HADS ‐ anxiety score (12 months).
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Analysis 1.29

Comparison 1 Action plan versus usual care, Outcome 29 HADS ‐ anxiety score (12 months).

Comparison 1 Action plan versus usual care, Outcome 30 SMI well knowledge.
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Analysis 1.30

Comparison 1 Action plan versus usual care, Outcome 30 SMI well knowledge.

Comparison 1 Action plan versus usual care, Outcome 31 SMI well actions.
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Analysis 1.31

Comparison 1 Action plan versus usual care, Outcome 31 SMI well actions.

Comparison 1 Action plan versus usual care, Outcome 32 SMI early exacerbation knowledge.
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Analysis 1.32

Comparison 1 Action plan versus usual care, Outcome 32 SMI early exacerbation knowledge.

Comparison 1 Action plan versus usual care, Outcome 33 SMI early exacerbation actions.
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Analysis 1.33

Comparison 1 Action plan versus usual care, Outcome 33 SMI early exacerbation actions.

Comparison 1 Action plan versus usual care, Outcome 34 SMI severe exacerbation knowledge.
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Analysis 1.34

Comparison 1 Action plan versus usual care, Outcome 34 SMI severe exacerbation knowledge.

Comparison 1 Action plan versus usual care, Outcome 35 SMI severe exacerbation actions.
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Analysis 1.35

Comparison 1 Action plan versus usual care, Outcome 35 SMI severe exacerbation actions.

Comparison 1 Action plan versus usual care, Outcome 36 COPD knowledge (change).
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Analysis 1.36

Comparison 1 Action plan versus usual care, Outcome 36 COPD knowledge (change).

Comparison 1 Action plan versus usual care, Outcome 37 Self‐management exacerbation actions (change).
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Analysis 1.37

Comparison 1 Action plan versus usual care, Outcome 37 Self‐management exacerbation actions (change).

Comparison 1 Action plan versus usual care, Outcome 38 Mortality.
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Analysis 1.38

Comparison 1 Action plan versus usual care, Outcome 38 Mortality.

Comparison 1 Action plan versus usual care, Outcome 39 % Days usual respiratory status (6 months).
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Analysis 1.39

Comparison 1 Action plan versus usual care, Outcome 39 % Days usual respiratory status (6 months).

Comparison 1 Action plan versus usual care, Outcome 40 % Days severely worse respiratory status (6 months).
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Analysis 1.40

Comparison 1 Action plan versus usual care, Outcome 40 % Days severely worse respiratory status (6 months).

Comparison 1 Action plan versus usual care, Outcome 41 FEV1 % predicted.
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Analysis 1.41

Comparison 1 Action plan versus usual care, Outcome 41 FEV1 % predicted.

Comparison 1 Action plan versus usual care, Outcome 42 Satisfaction with care.
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Analysis 1.42

Comparison 1 Action plan versus usual care, Outcome 42 Satisfaction with care.

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 1 SGRQ overall score (correlation imputation).
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Analysis 2.1

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 1 SGRQ overall score (correlation imputation).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 2 SGRQ overall score (other study SD).
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Analysis 2.2

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 2 SGRQ overall score (other study SD).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 3 SGRQ symptom score (correlation imputation).
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Analysis 2.3

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 3 SGRQ symptom score (correlation imputation).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 4 SGRQ symptom score (other study SD).
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Analysis 2.4

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 4 SGRQ symptom score (other study SD).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 5 SGRQ activity limitation score (correlation imputation).
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Analysis 2.5

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 5 SGRQ activity limitation score (correlation imputation).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 6 SGRQ activity limitation score (other study SD).
Figuras y tablas -
Analysis 2.6

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 6 SGRQ activity limitation score (other study SD).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 7 SGRQ impact score (correlation imputation).
Figuras y tablas -
Analysis 2.7

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 7 SGRQ impact score (correlation imputation).

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 8 SGRQ impact score (other study SD).
Figuras y tablas -
Analysis 2.8

Comparison 2 Action plan versus usual care ‐ sensitivity analysis, Outcome 8 SGRQ impact score (other study SD).

Summary of findings for the main comparison. Action plans, with limited patient education only, versus usual care for exacerbations of COPD

Action Plan versus usual care for exacerbations of chronic obstructive pulmonary disease

Patient or population: patients with exacerbations of chronic obstructive pulmonary disease
Settings: community or out‐patients
Intervention: Action Plan versus usual care

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

Action Plan versus usual care

Hospital admission
Follow‐up: 12 months

The mean hospital admission in the control groups was
0.5 admissions

The mean Hospital admission in the intervention groups was
0.23 higher
(0.03 lower to 0.49 higher)

205
(2 studies)

⊕⊕⊕⊝
moderate1

Emergency department attendance for COPD
Follow‐up: 12 months

The mean emergency department attendance for copd in the control groups was
0.4 visits

The mean Emergency department attendance for COPD in the intervention groups was
0.37 higher
(0.5 lower to 1.24 higher)

201
(2 studies)

⊕⊕⊕⊝
moderate1

GP visits/phone contacts for COPD (all or urgent)
Follow‐up: 6 to 12 months

The mean gp visits/phone contacts for copd (all or urgent) in the control groups was
4 contacts

The mean GP visits/phone contacts for COPD (all or urgent) in the intervention groups was
0.53 higher
(0.45 lower to 1.5 higher)

256
(3 studies)

⊕⊕⊕⊝
moderate1

Courses of oral corticosteroids
Follow‐up: 12 months

The mean courses of oral corticosteroids in the control groups was
1 course

The mean Courses of oral corticosteroids in the intervention groups was
0.74 higher
(0.12 to 1.35 higher)

200
(2 studies)

⊕⊕⊕⊝
moderate1

Improvement in SGRQ impact score
Follow‐up: 6 to 12 months

The mean improvement in sgrq impact score in the control groups was
0.35 units

The mean Improvement in SGRQ impact score in the intervention groups was
1.3 higher
(1.45 lower to 4.06 higher)

412
(4 studies)

⊕⊕⊕⊝
moderate1

*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;

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 Confidence interval includes both increase and decrease with action plan

Figuras y tablas -
Summary of findings for the main comparison. Action plans, with limited patient education only, versus usual care for exacerbations of COPD
Table 1. Study design

Study ID

Dates

Recruitment

RAN unit

Follow up

Length SME (educator)

RAN n /WD n

% Males

% Current smokers

Age*

(yrs)

FEV1 % pred*

INT‐CONT

QOL INT‐CONT

Martin 2004

Not known

Consortium practices, New Zealand

Patient

12 months

Single interview, length not stated (respiratory nurse)

96 / 26

51%

n/a

70

35 ‐ 34

57 ‐ 51

McGeoch 2004

7/2002 ‐ 12/2003

 2 groups of practices, New Zealand

Practice

12 months

1 hour (practice nurse or respiratory educator)

159 / 9

59%

28%

71

55 ‐ 53

43 ‐ 37

Rootmensen 2008 (all patients)

Not known

1 hospital pulmonary outpatients clinic, Netherlands

Patient

6 months

45 minutes (pulmonary nurse)

157 (111 COPD)/ 17

55%

12%

60

57 ‐ 64

n/a

Watson 1997

1993 ‐ 07/1994

12 practices, 22 GPs, New Zealand

Patient

6 months

Single interview, length not stated (practice nurse)

69 / 13

65%

28%

68

37 ‐ 36

43 ‐ 39

Wood‐Baker 2006

2002 ‐ 2003

54 GPs, 31 practices, Australia

Practice

12 months

1 hour (respiratory research nurse)

139 / 27

76%

42%

70

46 ‐ 44

47 ‐ 47

* = mean, INT‐CONT = intervention group‐control group, SME =self‐management education, AP = action plan, randomisation =RAN, WD= withdrawals or died, QOL = % impairment quaity of life 0‐100

Figuras y tablas -
Table 1. Study design
Table 2. Action Plan (AP) intervention and comparison used in included studies

Individualised written AP

Standard written AP

Individualised instructions AP

Individual SME

Prescription /supply OCS

Prescription /supply ABS

Booklet

Comparison

Martin 2004

Usual care by own GP

McGeoch 2004

Non‐standard education on COPD according to practice standards

Rootmensen 2008

Some

Some

Usual care

Watson 1997

✓ Guide to living positively with COPD

Usual care, specifically denied access to AP and booklet

Wood‐Baker 2006

2%

22%

✓ COPD information

Usual care, specifically denied action plan

SME =self‐management education, OCS=oral corticosteroids, ABS=antibiotics

Figuras y tablas -
Table 2. Action Plan (AP) intervention and comparison used in included studies
Comparison 1. Action plan versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hospital admission (12 months) Show forest plot

2

205

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.03, 0.49]

2 At least 1 hospital admission (12 months) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.31, 3.03]

3 Emergency department attendance for COPD (12 months) Show forest plot

2

201

Mean Difference (IV, Random, 95% CI)

0.37 [‐0.50, 1.24]

4 At least 1 emergency department attendance (12 months) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.64 [0.25, 1.66]

5 Ambulance calls (total) Show forest plot

1

89

Mean Difference (IV, Fixed, 95% CI)

1.70 [0.17, 3.23]

6 GP visits/phone contacts for COPD (all or urgent) Show forest plot

3

256

Mean Difference (IV, Fixed, 95% CI)

0.53 [‐0.45, 1.50]

6.1 6 months

1

56

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐0.57, 2.57]

6.2 12 months

2

200

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐1.02, 1.47]

7 GP visits/phone contacts (total or all non‐COPD) Show forest plot

2

200

Mean Difference (IV, Fixed, 95% CI)

1.25 [‐1.54, 4.03]

8 At least one GP visit (12 months) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

1.14 [0.60, 2.17]

9 Courses of oral corticosteroids (12 months) Show forest plot

2

200

Mean Difference (IV, Fixed, 95% CI)

0.74 [0.12, 1.35]

10 Courses of antibiotics (12 months) Show forest plot

2

200

Mean Difference (IV, Fixed, 95% CI)

0.78 [‐0.24, 1.79]

11 At least 1 course antibiotics for exacerbation Show forest plot

3

349

Peto Odds Ratio (Peto, Fixed, 95% CI)

2.02 [1.29, 3.17]

11.1 6 months

1

56

Peto Odds Ratio (Peto, Fixed, 95% CI)

6.51 [2.02, 21.05]

11.2 12 months

2

293

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.65 [1.01, 2.69]

12 At least 1 course oral steroids for exacerbation Show forest plot

2

210

Odds Ratio (M‐H, Fixed, 95% CI)

2.60 [0.98, 6.90]

12.1 6 months

1

56

Odds Ratio (M‐H, Fixed, 95% CI)

6.58 [1.29, 33.62]

12.2 12 months

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

1.27 [0.34, 4.69]

13 Days on corticosteroids (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [‐5.53, 17.53]

14 Days on antibiotics (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [1.40, 10.60]

15 At least 1 exacerbation of COPD in 6 months Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

16 SGRQ overall score Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

0.54 [‐1.98, 3.05]

16.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.37 [‐1.96, 6.70]

16.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐0.39 [‐3.48, 2.70]

17 SGRQ symptom score Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

2.25 [‐2.04, 6.54]

17.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

3.02 [‐4.26, 10.31]

17.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.84 [‐3.47, 7.14]

18 SGRQ activity limitation score Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

‐1.07 [‐4.45, 2.30]

18.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.56 [‐3.31, 8.44]

18.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐2.87 [‐5.00, 1.26]

19 SGRQ impact score Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐1.45, 4.06]

19.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

1.76 [‐2.79, 6.30]

19.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.04 [‐2.43, 4.51]

20 SF36 physical function (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐7.13, 7.73]

21 SF36 role limitation physical (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

9.0 [‐8.07, 26.07]

22 SF36 bodily pain at 6 months Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

18.5 [6.14, 30.86]

23 SF36 general health (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

2.60 [‐3.71, 8.91]

24 SF36 vitality (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

1.6 [‐4.73, 7.93]

25 SF36 social function (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

5.30 [‐4.68, 15.28]

26 SF36 role limitation emotional (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

7.5 [‐8.56, 23.56]

27 SF36 general mental health (6 months) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

6.3 [0.64, 11.96]

28 HADS ‐ depression score (12 months) Show forest plot

1

154

Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.64, 1.14]

29 HADS ‐ anxiety score (12 months) Show forest plot

1

154

Mean Difference (IV, Fixed, 95% CI)

0.14 [‐1.38, 1.66]

30 SMI well knowledge Show forest plot

1

Mean Difference (Fixed, 95% CI)

1.1 [0.46, 1.74]

31 SMI well actions Show forest plot

1

Mean Difference (Fixed, 95% CI)

0.5 [‐0.24, 1.24]

32 SMI early exacerbation knowledge Show forest plot

1

Mean Difference (Fixed, 95% CI)

1.80 [0.75, 2.85]

33 SMI early exacerbation actions Show forest plot

1

Mean Difference (Fixed, 95% CI)

2.3 [0.96, 3.64]

34 SMI severe exacerbation knowledge Show forest plot

1

Mean Difference (Fixed, 95% CI)

2.5 [0.94, 4.06]

35 SMI severe exacerbation actions Show forest plot

1

Mean Difference (Fixed, 95% CI)

1.5 [0.47, 2.53]

36 COPD knowledge (change) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

2.20 [‐3.71, 8.11]

37 Self‐management exacerbation actions (change) Show forest plot

1

90

Mean Difference (IV, Fixed, 95% CI)

‐5.1 [‐15.26, 5.06]

38 Mortality Show forest plot

3

391

Peto Odds Ratio (Peto, Fixed, 95% CI)

1.66 [0.73, 3.79]

39 % Days usual respiratory status (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

5.0 [‐14.39, 24.39]

40 % Days severely worse respiratory status (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐9.08, 9.08]

41 FEV1 % predicted Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

41.1 6 months

2

179

Mean Difference (IV, Fixed, 95% CI)

1.83 [‐1.05, 4.71]

41.2 12 months

1

112

Mean Difference (IV, Fixed, 95% CI)

2.00 [‐1.89, 5.89]

42 Satisfaction with care Show forest plot

1

89

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐3.47, 1.27]

Figuras y tablas -
Comparison 1. Action plan versus usual care
Comparison 2. Action plan versus usual care ‐ sensitivity analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 SGRQ overall score (correlation imputation) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

0.54 [‐1.98, 3.05]

1.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.37 [‐1.96, 6.70]

1.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐0.39 [‐3.48, 2.70]

2 SGRQ overall score (other study SD) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

0.94 [‐1.42, 3.31]

2.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.83 [‐0.84, 6.50]

2.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐0.39 [‐3.48, 2.70]

3 SGRQ symptom score (correlation imputation) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

2.25 [‐2.04, 6.54]

3.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

3.02 [‐4.26, 10.31]

3.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.84 [‐3.47, 7.14]

4 SGRQ symptom score (other study SD) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

1.64 [‐2.50, 5.78]

4.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

1.32 [‐5.30, 7.95]

4.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.84 [‐3.47, 7.14]

5 SGRQ activity limitation score (correlation imputation) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

‐1.07 [‐4.45, 2.30]

5.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.56 [‐3.31, 8.44]

5.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐2.87 [‐5.00, 1.26]

6 SGRQ activity limitation score (other study SD) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

‐0.62 [‐3.81, 2.56]

6.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.68 [‐2.32, 7.69]

6.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

‐2.87 [‐5.00, 1.26]

7 SGRQ impact score (correlation imputation) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐1.45, 4.06]

7.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

1.76 [‐2.79, 6.30]

7.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.04 [‐2.43, 4.51]

8 SGRQ impact score (other study SD) Show forest plot

4

412

Mean Difference (IV, Fixed, 95% CI)

1.57 [‐1.04, 4.19]

8.1 6 months

2

146

Mean Difference (IV, Fixed, 95% CI)

2.28 [‐1.71, 6.26]

8.2 12 months

2

266

Mean Difference (IV, Fixed, 95% CI)

1.04 [‐2.43, 4.51]

Figuras y tablas -
Comparison 2. Action plan versus usual care ‐ sensitivity analysis