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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

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

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Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 3

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

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Forest plot of comparison: 1 Action plan versus usual care, outcome: 1.18 Mortality (all cause) 12 months.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Action plan versus usual care, outcome: 1.18 Mortality (all cause) 12 months.

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Comparison 1 Action plan versus usual care, Outcome 1 Hospitalizations for COPD /100 patient years.
Figuras y tablas -
Analysis 1.1

Comparison 1 Action plan versus usual care, Outcome 1 Hospitalizations for COPD /100 patient years.

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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).

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Comparison 1 Action plan versus usual care, Outcome 3 at least 1 Hospital Admission (6 months).
Figuras y tablas -
Analysis 1.3

Comparison 1 Action plan versus usual care, Outcome 3 at least 1 Hospital Admission (6 months).

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Comparison 1 Action plan versus usual care, Outcome 4 Hospital admission (12 months).
Figuras y tablas -
Analysis 1.4

Comparison 1 Action plan versus usual care, Outcome 4 Hospital admission (12 months).

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Comparison 1 Action plan versus usual care, Outcome 5 Hospital Admission for COPD (6 months).
Figuras y tablas -
Analysis 1.5

Comparison 1 Action plan versus usual care, Outcome 5 Hospital Admission for COPD (6 months).

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Comparison 1 Action plan versus usual care, Outcome 6 Hospitalizations & emergency visits for COPD/100 patient years.
Figuras y tablas -
Analysis 1.6

Comparison 1 Action plan versus usual care, Outcome 6 Hospitalizations & emergency visits for COPD/100 patient years.

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Comparison 1 Action plan versus usual care, Outcome 7 At Least 1 Hospital or Emergency Department Visit for COPD.
Figuras y tablas -
Analysis 1.7

Comparison 1 Action plan versus usual care, Outcome 7 At Least 1 Hospital or Emergency Department Visit for COPD.

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Comparison 1 Action plan versus usual care, Outcome 8 Emergency department visits for COPD /100 patient years.
Figuras y tablas -
Analysis 1.8

Comparison 1 Action plan versus usual care, Outcome 8 Emergency department visits for COPD /100 patient years.

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Comparison 1 Action plan versus usual care, Outcome 9 Emergency department visit for COPD (12 months).
Figuras y tablas -
Analysis 1.9

Comparison 1 Action plan versus usual care, Outcome 9 Emergency department visit for COPD (12 months).

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Comparison 1 Action plan versus usual care, Outcome 10 At least 1 emergency department visit (12 months).
Figuras y tablas -
Analysis 1.10

Comparison 1 Action plan versus usual care, Outcome 10 At least 1 emergency department visit (12 months).

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Comparison 1 Action plan versus usual care, Outcome 11 Emergency Department Visits for COPD (6 months).
Figuras y tablas -
Analysis 1.11

Comparison 1 Action plan versus usual care, Outcome 11 Emergency Department Visits for COPD (6 months).

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Comparison 1 Action plan versus usual care, Outcome 12 GP visits/phone contacts for COPD (all or urgent).
Figuras y tablas -
Analysis 1.12

Comparison 1 Action plan versus usual care, Outcome 12 GP visits/phone contacts for COPD (all or urgent).

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Comparison 1 Action plan versus usual care, Outcome 13 GP visits/phone contacts (total/all non‐COPD) (12 months).
Figuras y tablas -
Analysis 1.13

Comparison 1 Action plan versus usual care, Outcome 13 GP visits/phone contacts (total/all non‐COPD) (12 months).

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Comparison 1 Action plan versus usual care, Outcome 14 Unscheduled Physician Visits (6 months).
Figuras y tablas -
Analysis 1.14

Comparison 1 Action plan versus usual care, Outcome 14 Unscheduled Physician Visits (6 months).

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Comparison 1 Action plan versus usual care, Outcome 15 Ambulance calls (total).
Figuras y tablas -
Analysis 1.15

Comparison 1 Action plan versus usual care, Outcome 15 Ambulance calls (total).

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Comparison 1 Action plan versus usual care, Outcome 16 Total Hospital Days (12 months).
Figuras y tablas -
Analysis 1.16

Comparison 1 Action plan versus usual care, Outcome 16 Total Hospital Days (12 months).

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Comparison 1 Action plan versus usual care, Outcome 17 Total ICU Days (12 months).
Figuras y tablas -
Analysis 1.17

Comparison 1 Action plan versus usual care, Outcome 17 Total ICU Days (12 months).

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Comparison 1 Action plan versus usual care, Outcome 18 Mortality (all cause) 12 months.
Figuras y tablas -
Analysis 1.18

Comparison 1 Action plan versus usual care, Outcome 18 Mortality (all cause) 12 months.

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Comparison 1 Action plan versus usual care, Outcome 19 Mortality (all cause) per 100 Patient‐Years (12 months).
Figuras y tablas -
Analysis 1.19

Comparison 1 Action plan versus usual care, Outcome 19 Mortality (all cause) per 100 Patient‐Years (12 months).

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Comparison 1 Action plan versus usual care, Outcome 20 Mortality (all cause) 6 months.
Figuras y tablas -
Analysis 1.20

Comparison 1 Action plan versus usual care, Outcome 20 Mortality (all cause) 6 months.

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Comparison 1 Action plan versus usual care, Outcome 21 At least 1 course oral steroids for exacerbation.
Figuras y tablas -
Analysis 1.21

Comparison 1 Action plan versus usual care, Outcome 21 At least 1 course oral steroids for exacerbation.

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Comparison 1 Action plan versus usual care, Outcome 22 Courses of oral corticosteroids (12 months).
Figuras y tablas -
Analysis 1.22

Comparison 1 Action plan versus usual care, Outcome 22 Courses of oral corticosteroids (12 months).

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Comparison 1 Action plan versus usual care, Outcome 23 Courses of Corticosteroids (6 months).
Figuras y tablas -
Analysis 1.23

Comparison 1 Action plan versus usual care, Outcome 23 Courses of Corticosteroids (6 months).

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Comparison 1 Action plan versus usual care, Outcome 24 Days on corticosteroids (6 months).
Figuras y tablas -
Analysis 1.24

Comparison 1 Action plan versus usual care, Outcome 24 Days on corticosteroids (6 months).

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Comparison 1 Action plan versus usual care, Outcome 25 Prednisolone mg (12 months).
Figuras y tablas -
Analysis 1.25

Comparison 1 Action plan versus usual care, Outcome 25 Prednisolone mg (12 months).

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Comparison 1 Action plan versus usual care, Outcome 26 At least 1 course antibiotics for exacerbation.
Figuras y tablas -
Analysis 1.26

Comparison 1 Action plan versus usual care, Outcome 26 At least 1 course antibiotics for exacerbation.

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Comparison 1 Action plan versus usual care, Outcome 27 Courses of antibiotics (12 months).
Figuras y tablas -
Analysis 1.27

Comparison 1 Action plan versus usual care, Outcome 27 Courses of antibiotics (12 months).

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Comparison 1 Action plan versus usual care, Outcome 28 Courses of Antibiotics (6 months).
Figuras y tablas -
Analysis 1.28

Comparison 1 Action plan versus usual care, Outcome 28 Courses of Antibiotics (6 months).

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Comparison 1 Action plan versus usual care, Outcome 29 Days on antibiotics (6 months).
Figuras y tablas -
Analysis 1.29

Comparison 1 Action plan versus usual care, Outcome 29 Days on antibiotics (6 months).

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Comparison 1 Action plan versus usual care, Outcome 30 SGRQ overall score (12 months).
Figuras y tablas -
Analysis 1.30

Comparison 1 Action plan versus usual care, Outcome 30 SGRQ overall score (12 months).

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Comparison 1 Action plan versus usual care, Outcome 31 SGRQ overall score (6 months).
Figuras y tablas -
Analysis 1.31

Comparison 1 Action plan versus usual care, Outcome 31 SGRQ overall score (6 months).

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Comparison 1 Action plan versus usual care, Outcome 32 SGRQ symptoms (12 months).
Figuras y tablas -
Analysis 1.32

Comparison 1 Action plan versus usual care, Outcome 32 SGRQ symptoms (12 months).

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Comparison 1 Action plan versus usual care, Outcome 33 SGRQ symptoms (6 months).
Figuras y tablas -
Analysis 1.33

Comparison 1 Action plan versus usual care, Outcome 33 SGRQ symptoms (6 months).

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Comparison 1 Action plan versus usual care, Outcome 34 SGRQ activity limitation (12 months).
Figuras y tablas -
Analysis 1.34

Comparison 1 Action plan versus usual care, Outcome 34 SGRQ activity limitation (12 months).

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Comparison 1 Action plan versus usual care, Outcome 35 SGRQ activity limitation (6 months).
Figuras y tablas -
Analysis 1.35

Comparison 1 Action plan versus usual care, Outcome 35 SGRQ activity limitation (6 months).

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Comparison 1 Action plan versus usual care, Outcome 36 SGRQ impact (12 months).
Figuras y tablas -
Analysis 1.36

Comparison 1 Action plan versus usual care, Outcome 36 SGRQ impact (12 months).

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Comparison 1 Action plan versus usual care, Outcome 37 SGRQ impact score (6 months).
Figuras y tablas -
Analysis 1.37

Comparison 1 Action plan versus usual care, Outcome 37 SGRQ impact score (6 months).

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Comparison 1 Action plan versus usual care, Outcome 38 SF36 physical function (6 months).
Figuras y tablas -
Analysis 1.38

Comparison 1 Action plan versus usual care, Outcome 38 SF36 physical function (6 months).

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Comparison 1 Action plan versus usual care, Outcome 39 SF36 role limitation physical (6 months).
Figuras y tablas -
Analysis 1.39

Comparison 1 Action plan versus usual care, Outcome 39 SF36 role limitation physical (6 months).

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Comparison 1 Action plan versus usual care, Outcome 40 SF36 bodily pain (6 months).
Figuras y tablas -
Analysis 1.40

Comparison 1 Action plan versus usual care, Outcome 40 SF36 bodily pain (6 months).

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Comparison 1 Action plan versus usual care, Outcome 41 SF36 general health (6 months).
Figuras y tablas -
Analysis 1.41

Comparison 1 Action plan versus usual care, Outcome 41 SF36 general health (6 months).

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Comparison 1 Action plan versus usual care, Outcome 42 SF36 vitality (6 months).
Figuras y tablas -
Analysis 1.42

Comparison 1 Action plan versus usual care, Outcome 42 SF36 vitality (6 months).

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Comparison 1 Action plan versus usual care, Outcome 43 SF36 mental health (6 months).
Figuras y tablas -
Analysis 1.43

Comparison 1 Action plan versus usual care, Outcome 43 SF36 mental health (6 months).

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Comparison 1 Action plan versus usual care, Outcome 44 SF36 role limitation emotional (6 months).
Figuras y tablas -
Analysis 1.44

Comparison 1 Action plan versus usual care, Outcome 44 SF36 role limitation emotional (6 months).

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Comparison 1 Action plan versus usual care, Outcome 45 SF36 social function (6 months).
Figuras y tablas -
Analysis 1.45

Comparison 1 Action plan versus usual care, Outcome 45 SF36 social function (6 months).

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Comparison 1 Action plan versus usual care, Outcome 46 HADS ‐ depression score (12 months).
Figuras y tablas -
Analysis 1.46

Comparison 1 Action plan versus usual care, Outcome 46 HADS ‐ depression score (12 months).

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Comparison 1 Action plan versus usual care, Outcome 47 HADS ‐ depression score (6 months).
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Analysis 1.47

Comparison 1 Action plan versus usual care, Outcome 47 HADS ‐ depression score (6 months).

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Comparison 1 Action plan versus usual care, Outcome 48 HADS ‐ anxiety score (12 months).
Figuras y tablas -
Analysis 1.48

Comparison 1 Action plan versus usual care, Outcome 48 HADS ‐ anxiety score (12 months).

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Comparison 1 Action plan versus usual care, Outcome 49 HADS ‐ anxiety score (6 months).
Figuras y tablas -
Analysis 1.49

Comparison 1 Action plan versus usual care, Outcome 49 HADS ‐ anxiety score (6 months).

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Comparison 1 Action plan versus usual care, Outcome 50 Exacerbation knowledge when well (12 months).
Figuras y tablas -
Analysis 1.50

Comparison 1 Action plan versus usual care, Outcome 50 Exacerbation knowledge when well (12 months).

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Comparison 1 Action plan versus usual care, Outcome 51 Exacerbation actions when well (12 months).
Figuras y tablas -
Analysis 1.51

Comparison 1 Action plan versus usual care, Outcome 51 Exacerbation actions when well (12 months).

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Comparison 1 Action plan versus usual care, Outcome 52 Early exacerbation knowledge (12 months).
Figuras y tablas -
Analysis 1.52

Comparison 1 Action plan versus usual care, Outcome 52 Early exacerbation knowledge (12 months).

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Comparison 1 Action plan versus usual care, Outcome 53 Early exacerbation actions (12 months).
Figuras y tablas -
Analysis 1.53

Comparison 1 Action plan versus usual care, Outcome 53 Early exacerbation actions (12 months).

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Comparison 1 Action plan versus usual care, Outcome 54 Severe exacerbation knowledge (12 months).
Figuras y tablas -
Analysis 1.54

Comparison 1 Action plan versus usual care, Outcome 54 Severe exacerbation knowledge (12 months).

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Comparison 1 Action plan versus usual care, Outcome 55 Severe exacerbation actions (12 months).
Figuras y tablas -
Analysis 1.55

Comparison 1 Action plan versus usual care, Outcome 55 Severe exacerbation actions (12 months).

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Comparison 1 Action plan versus usual care, Outcome 56 Self‐management exacerbation actions (6 months).
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Analysis 1.56

Comparison 1 Action plan versus usual care, Outcome 56 Self‐management exacerbation actions (6 months).

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Comparison 1 Action plan versus usual care, Outcome 57 Self‐efficacy for Exacerbation Recognition (6 months).
Figuras y tablas -
Analysis 1.57

Comparison 1 Action plan versus usual care, Outcome 57 Self‐efficacy for Exacerbation Recognition (6 months).

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Comparison 1 Action plan versus usual care, Outcome 58 Self‐efficacy for Exacerbation Prevention/Action (6 months).
Figuras y tablas -
Analysis 1.58

Comparison 1 Action plan versus usual care, Outcome 58 Self‐efficacy for Exacerbation Prevention/Action (6 months).

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Comparison 1 Action plan versus usual care, Outcome 59 FEV1 % predicted.
Figuras y tablas -
Analysis 1.59

Comparison 1 Action plan versus usual care, Outcome 59 FEV1 % predicted.

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Comparison 1 Action plan versus usual care, Outcome 60 Cost HADM per patient US$ (12 months).
Figuras y tablas -
Analysis 1.60

Comparison 1 Action plan versus usual care, Outcome 60 Cost HADM per patient US$ (12 months).

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Comparison 1 Action plan versus usual care, Outcome 61 Cost EDV Per Patient US$ (12 months).
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Analysis 1.61

Comparison 1 Action plan versus usual care, Outcome 61 Cost EDV Per Patient US$ (12 months).

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Comparison 1 Action plan versus usual care, Outcome 62 Cost Pulmonary Drug Prescriptions per Patient US$ (12 months).
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Analysis 1.62

Comparison 1 Action plan versus usual care, Outcome 62 Cost Pulmonary Drug Prescriptions per Patient US$ (12 months).

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Summary of findings for the main comparison. Action plan versus usual care for exacerbations of chronic obstructive pulmonary disease

Do action plans improve patient outcomes in acute exacerbations of chronic obstructive pulmonary disease

Patient or population: individuals with exacerbations of chronic obstructive pulmonary disease
Setting: community and outpatient setting
Intervention: action plan
Comparison: usual care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with usual care

Risk with action plan

Hospitalisations for COPD/100 patient‐years (action plan + phone follow‐up)
Follow‐up: 12 months

Rate ratio 0.69
(0.47 to 1.01)

743
(1 RCT)

⊕⊕⊕⊝
Moderatea

Hospitalisations and emergency visits for COPD/100 patient‐years (action plan + phone follow‐up)
Follow‐up: 12 months

Rate ratio 0.59
(0.44 to 0.79)

743
(1 RCT)

⊕⊕⊕⊕
High

At least 1 hospital admission
Follow‐up: 12 months

209 per 1000

154 per 1000
(114 to 204)

Odds ratio 0.69
(0.49 to 0.97)

897
(2 RCTs)

⊕⊕⊕⊝
Moderateb

Mortality (all‐cause)
Follow‐up: 12 months

103 per 1000

91 per 1000
(63 to 130)

Odds ratio 0.88
(0.59 to 1.31)

1134
(4 RCTs)

⊕⊕⊕⊝
Moderatea

Courses of oral corticosteroids
Follow‐up: 12 months

Mean courses of oral corticosteroids were 1.05

Mean courses of oral corticosteroids in the intervention group were 0.74 more (0.12 more to 1.35 more)

‐

200
(2 RCTs)

⊕⊕⊕⊝
Moderateb

Courses of antibiotics
Follow‐up: 12 months

Mean courses of antibiotics ranged from 1.6 to 3.2

Mean courses of antibiotics in the intervention group were 2.26 more (1.82 more to 2.7 more)

‐

943
(3 RCTs)

⊕⊕⊕⊝
Moderatec

Not downgraded for presence of substantial heterogeneity, which is explicable by differences in study design

Respiratory‐related quality of life: SGRQ overall score
Scale from 0 (best) to 100 (maximum impairment)
Follow‐up: 12 months

Mean respiratory‐related quality of life: SGRQ overall score ranged from ‐2 to +6 units

Mean respiratory‐related quality of life: SGRQ overall score in the intervention group was 2.82 units lower (0.83 lower to 4.81 lower)

‐

1009
(3 RCTs)

⊕⊕⊕⊝
Moderatec

Not downgraded for presence of substantial heterogeneity, which is explicable by differences in study design

Depression score
assessed with HADS
Scale from 0 to 21 (worst)
Follow‐up: 12 months

Mean depression score was ‐0.04

Mean depression score in the intervention group was 0.25 lower (1.14 lower to 0.64 higher)

‐

154
(1 RCT)

⊕⊕⊝⊝
Lowa,d

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; OR: odds ratio; RR: rate ratio.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

aWide confidence interval; effect size includes null.

bUnclear risk of bias for two studies for allocation and blinding of assessors.

cUnclear risk of bias for three studies for allocation and blinding of assessors.

dUnclear risk of bias for one study for allocation and blinding of assessors.

Figuras y tablas -
Summary of findings for the main comparison. Action plan versus usual care for exacerbations of chronic obstructive pulmonary disease
Ir a la tabla de la revisión
Table 1. Study design

Study ID

Dates

Recruitment/Randomisation unit

Follow‐up

Length SME (educator)

RAN, n/WD, n

Age*,

years/

% male

% current smokers

FEV1 % pred*

INT‐CONT

QoL INT‐CONT

Martin 2004

Not known

Consortium practices, New Zealand/participants

12 months

Single interview, length not stated (respiratory nurse)

96/26

70/51

n/a

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

71/59

28

55‐53

43‐37

Rootmensen 2008 (all participants)

Not known

1 hospital pulmonary outpatient clinic, Netherlands/ participants

6 months

45 minutes (pulmonary nurse)

157 (111 COPD)/17

60/55

12

57‐64

n/a

Rice 2010

07/2004‐ 07/2008

Centralised electronic medical record database/participants

12 months

1 to 1.5‐hour group educational session (case manager)

743/84

70/98

22

36.1‐38.1

n/a

Trappenburg 2011

12/2008‐ 12/2010

8 regional hospitals and 5 general practices/participants (stratified by gender and centre)

6 months

Single interview, length not stated (nurse case manager).

233/41

66/57

29

56.7‐56.5

n/a

Watson 1997

1993‐ 07/1994

12 practices, 22 GPs, New Zealand/participants

6 months

Single interview, length not stated (practice nurse)

69/13

68/65

28

37‐36

43‐39

Wood‐Baker 2006

2002‐2003

54 GPs, 31 practices, Australia/practice

12 months

1 hour (respiratory research nurse)

139/27

70/76

42

46‐44

47‐47

*: mean; AP: action plan; COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in one second; GP: general practitioner; INT‐CONT: intervention group‐control group; QoL: % impairment quality of life 0‐100; RAN: randomisation; SME: self‐management education; WD: withdrawal or death.

Figuras y tablas -
Table 1. Study design
Ir a la tabla de la revisión
Table 2. Action plan (AP) intervention and comparison used in included studies

Individualised AP

Standard written AP

Support for AP during study period

SME (individual/group)

Prescription /supply OCS

Prescription /supply ABS

Written COPD educational component

Comparison

Martin 2004

Written

3‐Monthly visit regarding use of AP

Individual interview with respiratory nurse, length not stated, individualised action plan according to current treatment and symptoms

All had 7‐day supply

All had 7‐day supply

No

Usual care by own GP

McGeoch 2004

Yes

No

Individual session by practice nurse or respiratory educator in association with GP 1 hour, covering major points of COPD self‐management plan, and use of validated sputum colour charts

Prescription

Prescription

Educational package

Non‐standard education on COPD according to practice standards

Rice 2010

Written

Monthly phone call from nurse

Group 1‐1.5 hours, individualised action plan with respiratory nurse

Yes

Prescription

Usual care + 1‐page summary of principles of COPD care according to published guidelines. No AP

Rootmensen 2008

Oral

No

Individual protocol‐based educational session covering disease, medications, vaccination, smoking cessation and exacerbation management, 45 minutes in length

Oral medication provided to some, % unknown

Oral medication provided to some, % unknown

No

Usual care

Trappenburg 2011

Written

Standardised phone calls at 1 and 4 months

Individualised action plan education, length of session not stated

2%'

22%

✓ COPD information

Usual care ‐ pharmacological and non‐pharmacological care according to most recent evidence‐based guidelines, specifically AP denied. All included participants seen by respiratory nurse, who systematically checked and discussed aspects of COPD care, including vaccination, optimisation of medication, inhalation techniques, exercise, nutritional aspects, smoking (cessation) and exacerbation management.

Watson 1997

Yes

No

Individual session education about use of the action plan with COPD booklet by a senior respiratory outreach nurse; length not stated

Prescription

Prescription

✓ Guide to living positively with COPD

Usual care by GP, specifically denied access to AP and booklet

Wood‐Baker 2006

Written

No

Individual educational session with respiratory nurse, covering COPD, smoking cessation, immunisation, nutrition, exercise, sputum clearance, breathing, medication, inhaler use. Individualised action plan developed with GP input. Length not known

2%

22%

COPD information booklet

Usual care, COPD information booklet and individual educational session with nurse, but no AP

ABS: antibiotics; AP: action plan; COPD: chronic obstructive pulmonary disease; GP: general practitioner; OCS: oral corticosteroids; SME: self‐management education.

Figuras y tablas -
Table 2. Action plan (AP) intervention and comparison used in included studies
Ir a la tabla de la revisión
Table 3. Generic health‐related quality of life subdomains: measured by Short Form (SF)‐36

Outcome

SF‐36 domain

Mean difference

95% CI

Analysis 1.38

Physical function

0.30

‐7.13 to 7.73

Analysis 1.39

Role limitation

9.00

‐8.07 to 26.07

Analysis 1.40

Bodily pain

18.50

6.14 to 30.86

Analysis 1.41

General health

2.60

‐3.71 to 8.91

Analysis 1.42

Vitality

1.60

‐4.73 to 7.93

Analysis 1.43

Social function

5.30

‐4.68 to 15.28

Analysis 1.44

Role limitation

7.50

‐8.56 to 23.56

Analysis 1.45

Mental health

6.30

0.64 to 11.96
Figuras y tablas -
Table 3. Generic health‐related quality of life subdomains: measured by Short Form (SF)‐36
Ir a la tabla de la revisión
Table 4. Psychological morbidity: anxiety and depression

Outcome

Domain

Follow‐up: months

MD

95% CI

n

Analysis 1.46

Depression

12

‐0.25

‐1.14 to 0.64

154

Analysis 1.47

Depression

6

0.10

‐0.73 to 0.93

183

Analysis 1.48

Anxiety

12

0.14

‐1.38 to 1.66

154

Analysis 1.49

Anxiety

6

0.00

‐0.83 to 0.83

183
Figuras y tablas -
Table 4. Psychological morbidity: anxiety and depression
Ir a la tabla de la revisión
Table 5. COPD self‐management for exacerbation and related self‐efficacy

Outcome

Study

Item

Direction improvement

Months

MD

95% CI

n

Analysis 1.50

McGeoch 2004

Self‐management knowledge when well

+

12

1.10

0.46 to 1.74

154

Analysis 1.51

McGeoch 2004

Self‐management actions when well

+

12

0.50

‐0.24 to 1.24

154

Analysis 1.52

McGeoch 2004

Self‐management knowledge early exacerbation

+

12

1.80

0.75 to 2.85

154

Analysis 1.53

McGeoch 2004

Self‐management actions early exacerbation

+

12

2.30

0.96 to 3.64

154

Analysis 1.54

McGeoch 2004

Self‐management knowledge severe exacerbation

+

12

2.50

0.94 to 4.06

154

Analysis 1.55

McGeoch 2004

Self‐management action severe exacerbation

+

12

1.50

0.47 to 2.53

154

Analysis 1.56

Rootmensen 2008

Self‐management exacerbation actions

+

6

‐5.10

‐15.26 to

5.06

90

Analysis 1.57

Trappenburg 2011

Self‐efficacy for exacerbation recognition

‐

6

‐0.70

‐0.98 to ‐0.42

183

Analysis 1.58

Trappenburg 2011

Self‐efficacy for exacerbation prevention/action

‐

6

‐0.90

‐1.18 to ‐0.62

183
Figuras y tablas -
Table 5. COPD self‐management for exacerbation and related self‐efficacy
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Comparison 1. Action plan versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hospitalizations for COPD /100 patient years Show forest plot

1

743

Rate Ratio (Fixed, 95% CI)

0.69 [0.47, 1.01]

1.1 Action Plan +phone follow up

1

743

Rate Ratio (Fixed, 95% CI)

0.69 [0.47, 1.01]

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

2

897

Odds Ratio (M‐H, Fixed, 95% CI)

0.69 [0.49, 0.97]

2.1 Action Plan

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.31, 3.03]

2.2 Action Plan + Phonecall Follow‐up

1

743

Odds Ratio (M‐H, Fixed, 95% CI)

0.66 [0.46, 0.95]

3 at least 1 Hospital Admission (6 months) Show forest plot

1

227

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.30, 2.31]

3.1 Action Plan with Phone Call Follow‐up

1

227

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.30, 2.31]

4 Hospital admission (12 months) Show forest plot

2

205

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.03, 0.49]

4.1 Action Plan

2

205

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.03, 0.49]

5 Hospital Admission for COPD (6 months) Show forest plot

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.08, 0.08]

5.1 Action Plan with Phone Call Follow‐up

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.08, 0.08]

6 Hospitalizations & emergency visits for COPD/100 patient years Show forest plot

1

743

Rate Ratio (Fixed, 95% CI)

0.59 [0.44, 0.79]

6.1 Action Plan +phone follow up

1

743

Rate Ratio (Fixed, 95% CI)

0.59 [0.44, 0.79]

7 At Least 1 Hospital or Emergency Department Visit for COPD Show forest plot

1

743

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.43, 0.80]

7.1 Action Plan with Phone Call Follow‐up

1

743

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.43, 0.80]

8 Emergency department visits for COPD /100 patient years Show forest plot

1

743

Rate Ratio (Fixed, 95% CI)

0.49 [0.33, 0.73]

8.1 Action Plan +phone follow up

1

743

Rate Ratio (Fixed, 95% CI)

0.49 [0.33, 0.73]

9 Emergency department visit for COPD (12 months) Show forest plot

2

201

Mean Difference (IV, Random, 95% CI)

0.37 [‐0.50, 1.24]

9.1 Action Plan

2

201

Mean Difference (IV, Random, 95% CI)

0.37 [‐0.50, 1.24]

10 At least 1 emergency department visit (12 months) Show forest plot

2

897

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.38, 0.78]

10.1 Action Plan

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.64 [0.25, 1.66]

10.2 Action Plan + Phone Call Follow‐up

1

743

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.36, 0.78]

11 Emergency Department Visits for COPD (6 months) Show forest plot

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.09, 0.09]

11.1 Action Plan with Phone Call Follow‐up

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.09, 0.09]

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

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 Action Plan (6 months)

1

56

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐0.57, 2.57]

12.2 Action Plan (12 months)

2

200

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐1.02, 1.47]

13 GP visits/phone contacts (total/all non‐COPD) (12 months) Show forest plot

2

200

Mean Difference (IV, Fixed, 95% CI)

1.25 [‐1.54, 4.03]

13.1 Action Plan

2

200

Mean Difference (IV, Fixed, 95% CI)

1.25 [‐1.54, 4.03]

14 Unscheduled Physician Visits (6 months) Show forest plot

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.36, 0.36]

14.1 Action Plan with Phonecall Follow‐up

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.36, 0.36]

15 Ambulance calls (total) Show forest plot

1

89

Mean Difference (IV, Fixed, 95% CI)

1.70 [0.17, 3.23]

15.1 Action Plan

1

89

Mean Difference (IV, Fixed, 95% CI)

1.70 [0.17, 3.23]

16 Total Hospital Days (12 months) Show forest plot

1

743

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [0.00, ‐0.20]

16.1 Action Plan + Phone Call Folow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [0.00, ‐0.20]

17 Total ICU Days (12 months) Show forest plot

1

743

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.60, ‐0.00]

17.1 Action Plan + Phone Call Folow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.60, ‐0.00]

18 Mortality (all cause) 12 months Show forest plot

4

1134

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

0.88 [0.59, 1.31]

18.1 Action Plan

3

391

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

1.66 [0.73, 3.79]

18.2 Action Plan with Phone call follow up

1

743

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

0.72 [0.46, 1.14]

19 Mortality (all cause) per 100 Patient‐Years (12 months) Show forest plot

1

743

Mean Difference (IV, Fixed, 95% CI)

‐3.70 [‐8.86, 1.46]

19.1 Action Plan with Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐3.70 [‐8.86, 1.46]

20 Mortality (all cause) 6 months Show forest plot

1

229

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

1.06 [0.15, 7.66]

20.1 Action Plan with Phone Call Follow‐up

1

229

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

1.06 [0.15, 7.66]

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

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

21.1 Action Plan (6 months)

1

56

Odds Ratio (M‐H, Fixed, 95% CI)

6.58 [1.29, 33.62]

21.2 Action Plan (12 months)

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

1.27 [0.34, 4.69]

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

2

200

Mean Difference (IV, Fixed, 95% CI)

0.74 [0.12, 1.35]

22.1 Action Plan

2

200

Mean Difference (IV, Fixed, 95% CI)

0.74 [0.12, 1.35]

23 Courses of Corticosteroids (6 months) Show forest plot

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.23, 0.23]

23.1 Action Plan with Phone Call Follow‐up

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.23, 0.23]

24 Days on corticosteroids (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [‐5.53, 17.53]

24.1 Action Plan

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [‐5.53, 17.53]

25 Prednisolone mg (12 months) Show forest plot

1

743

Mean Difference (IV, Fixed, 95% CI)

779.0 [533.23, 1024.77]

25.1 Action Plan with Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

779.0 [533.23, 1024.77]

26 At least 1 course antibiotics for exacerbation Show forest plot

3

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

Subtotals only

26.1 Action Plan (6 months)

1

56

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

6.51 [2.02, 21.05]

26.2 Action Plan (12 months)

2

293

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

1.65 [1.01, 2.69]

27 Courses of antibiotics (12 months) Show forest plot

3

943

Mean Difference (IV, Fixed, 95% CI)

2.26 [1.82, 2.70]

27.1 Action Plan

2

200

Mean Difference (IV, Fixed, 95% CI)

0.78 [‐0.24, 1.79]

27.2 Action Plan with Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

2.6 [2.12, 3.08]

28 Courses of Antibiotics (6 months) Show forest plot

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.26, 0.26]

28.1 Action Plan with Phone Call Follow‐up

1

227

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.26, 0.26]

29 Days on antibiotics (6 months) Show forest plot

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [1.40, 10.60]

29.1 Action Plan

1

56

Mean Difference (IV, Fixed, 95% CI)

6.0 [1.40, 10.60]

30 SGRQ overall score (12 months) Show forest plot

3

1009

Mean Difference (IV, Fixed, 95% CI)

‐2.79 [‐4.77, ‐0.82]

30.1 Action Plan

2

266

Mean Difference (IV, Fixed, 95% CI)

0.32 [‐2.70, 3.34]

30.2 Action Plan + Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐5.10 [‐7.70, ‐2.50]

31 SGRQ overall score (6 months) Show forest plot

4

452

Mean Difference (IV, Fixed, 95% CI)

‐0.83 [‐2.93, 1.27]

31.1 Action Plan

3

269

Mean Difference (IV, Fixed, 95% CI)

‐0.33 [‐3.03, 2.37]

31.2 Action Plan + Phone Call Follow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

‐1.6 [‐4.94, 1.74]

32 SGRQ symptoms (12 months) Show forest plot

2

266

Mean Difference (IV, Fixed, 95% CI)

‐1.84 [‐7.14, 3.47]

32.1 Action Plan

2

266

Mean Difference (IV, Fixed, 95% CI)

‐1.84 [‐7.14, 3.47]

33 SGRQ symptoms (6 months) Show forest plot

4

448

Mean Difference (IV, Fixed, 95% CI)

‐2.55 [‐6.92, 1.83]

33.1 Action Plan

3

265

Mean Difference (IV, Fixed, 95% CI)

‐2.07 [‐8.34, 4.20]

33.2 Action Plan + Phone Call Follow‐up (change from baseline)

1

183

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐9.10, 3.10]

34 SGRQ activity limitation (12 months) Show forest plot

2

266

Mean Difference (IV, Fixed, 95% CI)

2.87 [‐1.26, 7.00]

34.1 Action Plan

2

266

Mean Difference (IV, Fixed, 95% CI)

2.87 [‐1.26, 7.00]

35 SGRQ activity limitation (6 months) Show forest plot

4

452

Mean Difference (IV, Fixed, 95% CI)

0.88 [‐1.90, 3.67]

35.1 Action Plan

3

269

Mean Difference (IV, Fixed, 95% CI)

1.41 [‐1.99, 4.82]

35.2 Action Plan + Phone Call Follow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐5.05, 4.65]

36 SGRQ impact (12 months) Show forest plot

2

266

Mean Difference (IV, Fixed, 95% CI)

‐1.04 [‐4.51, 2.43]

36.1 Action Plan

2

266

Mean Difference (IV, Fixed, 95% CI)

‐1.04 [‐4.51, 2.43]

37 SGRQ impact score (6 months) Show forest plot

4

452

Mean Difference (IV, Fixed, 95% CI)

‐1.26 [‐3.47, 0.95]

37.1 Action Plan

3

269

Mean Difference (IV, Fixed, 95% CI)

‐1.53 [‐4.45, 1.39]

37.2 Action Plan + Phone Call Follow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

‐0.9 [‐4.27, 2.47]

38 SF36 physical function (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

38.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐7.13, 7.73]

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

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

39.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

9.0 [‐8.07, 26.07]

40 SF36 bodily pain (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

40.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

18.5 [6.14, 30.86]

41 SF36 general health (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

41.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

2.60 [‐3.71, 8.91]

42 SF36 vitality (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

42.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

1.6 [‐4.73, 7.93]

43 SF36 mental health (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

43.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

6.3 [0.64, 11.96]

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

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

44.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

7.5 [‐8.56, 23.56]

45 SF36 social function (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

45.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

5.30 [‐4.68, 15.28]

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

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

46.1 Action Plan

1

154

Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐1.14, 0.64]

47 HADS ‐ depression score (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

47.1 Action Plan + Phone Call Folow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.73, 0.93]

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

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

48.1 Action Plan

1

154

Mean Difference (IV, Fixed, 95% CI)

0.14 [‐1.38, 1.66]

49 HADS ‐ anxiety score (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

49.1 Action Plan + Phone Call Follow‐up (change from baseline)

1

183

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.83, 0.83]

50 Exacerbation knowledge when well (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

50.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

1.1 [0.46, 1.74]

51 Exacerbation actions when well (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

51.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

0.5 [‐0.24, 1.24]

52 Early exacerbation knowledge (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

52.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

1.80 [0.75, 2.85]

53 Early exacerbation actions (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

53.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

2.3 [0.96, 3.64]

54 Severe exacerbation knowledge (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

54.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

2.5 [0.94, 4.06]

55 Severe exacerbation actions (12 months) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Subtotals only

55.1 Action Plan

1

154

Mean Difference (Fixed, 95% CI)

1.5 [0.47, 2.53]

56 Self‐management exacerbation actions (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

56.1 Action Plan

1

90

Mean Difference (IV, Fixed, 95% CI)

‐5.1 [‐15.26, 5.06]

57 Self‐efficacy for Exacerbation Recognition (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

57.1 Action Plan + Phone Call Follow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐0.98, ‐0.42]

58 Self‐efficacy for Exacerbation Prevention/Action (6 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

58.1 Action Plan + Phone Call Follow‐up

1

183

Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐1.18, ‐0.62]

59 FEV1 % predicted Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

59.1 6 months

2

179

Mean Difference (IV, Fixed, 95% CI)

1.83 [‐1.05, 4.71]

59.2 12 months

1

112

Mean Difference (IV, Fixed, 95% CI)

2.00 [‐1.89, 5.89]

60 Cost HADM per patient US$ (12 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

60.1 Action Plan with Phone Call Folow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐1117.0 [‐1754.50, ‐479.50]

61 Cost EDV Per Patient US$ (12 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

61.1 Action Plan with Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

‐141.0 [‐234.31, ‐47.69]

62 Cost Pulmonary Drug Prescriptions per Patient US$ (12 months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

62.1 Action Plan with Phone Call Follow‐up

1

743

Mean Difference (IV, Fixed, 95% CI)

15.00 [‐6.32, 36.32]
Figuras y tablas -
Comparison 1. Action plan versus usual care
Ir a la tabla de la revisión