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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Study flow diagram
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Figure 2

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Early rehab versus usual care, Outcome 1 SGRQ Total: mean difference.
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Analysis 1.1

Comparison 1 Early rehab versus usual care, Outcome 1 SGRQ Total: mean difference.

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Comparison 1 Early rehab versus usual care, Outcome 2 FEV1 L: mean difference.
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Analysis 1.2

Comparison 1 Early rehab versus usual care, Outcome 2 FEV1 L: mean difference.

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Comparison 1 Early rehab versus usual care, Outcome 3 Mortality.
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Analysis 1.3

Comparison 1 Early rehab versus usual care, Outcome 3 Mortality.

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Comparison 2 Expert patient programme versus usual care, Outcome 1 SGRQ Total: mean difference.
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Analysis 2.1

Comparison 2 Expert patient programme versus usual care, Outcome 1 SGRQ Total: mean difference.

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Comparison 2 Expert patient programme versus usual care, Outcome 2 Self‐efficacy: Exercise.
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Analysis 2.2

Comparison 2 Expert patient programme versus usual care, Outcome 2 Self‐efficacy: Exercise.

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Comparison 2 Expert patient programme versus usual care, Outcome 3 Self‐efficacy: Disease info.
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Analysis 2.3

Comparison 2 Expert patient programme versus usual care, Outcome 3 Self‐efficacy: Disease info.

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Comparison 2 Expert patient programme versus usual care, Outcome 4 Self‐efficacy: Obtain help.
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Analysis 2.4

Comparison 2 Expert patient programme versus usual care, Outcome 4 Self‐efficacy: Obtain help.

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Comparison 2 Expert patient programme versus usual care, Outcome 5 Self‐efficacy: Communication.
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Analysis 2.5

Comparison 2 Expert patient programme versus usual care, Outcome 5 Self‐efficacy: Communication.

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Comparison 2 Expert patient programme versus usual care, Outcome 6 Self‐efficacy: Manage disease.
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Analysis 2.6

Comparison 2 Expert patient programme versus usual care, Outcome 6 Self‐efficacy: Manage disease.

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Comparison 2 Expert patient programme versus usual care, Outcome 7 Self‐efficacy: Do chores.
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Analysis 2.7

Comparison 2 Expert patient programme versus usual care, Outcome 7 Self‐efficacy: Do chores.

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Comparison 2 Expert patient programme versus usual care, Outcome 8 Self‐efficacy: Social activity.
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Analysis 2.8

Comparison 2 Expert patient programme versus usual care, Outcome 8 Self‐efficacy: Social activity.

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Comparison 2 Expert patient programme versus usual care, Outcome 9 Self‐efficacy: Manage symptoms.
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Analysis 2.9

Comparison 2 Expert patient programme versus usual care, Outcome 9 Self‐efficacy: Manage symptoms.

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Comparison 2 Expert patient programme versus usual care, Outcome 10 Self‐efficacy: Manage breathlessness.
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Analysis 2.10

Comparison 2 Expert patient programme versus usual care, Outcome 10 Self‐efficacy: Manage breathlessness.

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Comparison 2 Expert patient programme versus usual care, Outcome 11 Self‐efficacy: Manage depression.
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Analysis 2.11

Comparison 2 Expert patient programme versus usual care, Outcome 11 Self‐efficacy: Manage depression.

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Summary of findings for the main comparison. Self‐management compared to usual care for bronchiectasis

Self‐management compared to usual care for bronchiectasis

Patient or population: people with non‐cystic fibrosis bronchiectasis
Setting: community
Intervention: self‐management
Comparison: usual care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with usual care

Risk with self‐management

Health‐related quality of life
assessed with: SGRQ
Scale from: 0 to 100, lower score is better
Follow‐up: range 6 weeks to 12 months

The mean health‐related quality of life was 56.02 points

MD 10.27 lower
(45.15 lower to 24.61 higher)

‐

20
(1 RCT)

⊕⊝⊝⊝
Very low1, 2, 3

No clear benefit or harm from self‐management (very low‐quality evidence)

Health‐related quality of life
assessed with: SGRQ
Scale from: 0 to 100, lower score is better

Follow up: range post‐intervention to 6 months

The mean health‐related quality of life was 44.7 points

MD 3.2 higher
(6.64 lower to 13.04 higher)

‐

60
(1 RCT)

⊕⊕⊝⊝
Low1, 3

No clear benefit or harm from self‐management

Exacerbations requiring antibiotics

‐

‐

‐

‐

‐

Not reported

Serious adverse events: mortality

‐

‐

not estimable

20
(1 RCT)

Hospital admissions (number admitted at least once)
Follow‐up: range 6 weeks to 12 months

‐

‐

not estimable

20
(1 RCT)

‐

Lung function assessed with: FEV1 L
Follow‐up: discharge to 12 months

The mean FEV1 was 1.03 L

MD 0.3 higher
(1.11 lower to 1.71 higher)

‐

20
(1 RCT)

⊕⊝⊝⊝
Very low1, 2, 3

No clear benefit or harm from self‐management

Self‐efficacy assessed with: CDSS
Scale from: 0 to 10

Follow‐up: postintervention to 6 months

‐

‐

not estimable

60
(1 RCT)

⊕⊕⊝⊝
Low1, 3

Six out of ten scales showed significant improvements over time with the intervention. We elected not to include all 10 scales in the table but graded the evidence based on overall quality of the study

Economic costs

‐

‐

‐

‐

‐

Not reported

*The risk in the intervention group (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).

CDSS: Chronic Disease Self‐efficacy Scale; CI: confidence interval; FEV1: forced expiratory volume in one second MD: mean difference; SGRQ: St George's Respiratory Questionnaire

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1One point deducted for the unblinded nature of the comparison.
2One point deducted for baseline imbalances.
3One point deducted for risk of bias from an underpowered study. Figure 1

Figuras y tablas -
Summary of findings for the main comparison. Self‐management compared to usual care for bronchiectasis
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Comparison 1. Early rehab versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 SGRQ Total: mean difference Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 6 weeks

1

13

Mean Difference (IV, Fixed, 95% CI)

‐12.70 [‐30.39, 4.99]

1.2 3 months

1

12

Mean Difference (IV, Fixed, 95% CI)

‐9.15 [‐28.08, 9.78]

1.3 12 months

1

7

Mean Difference (IV, Fixed, 95% CI)

‐10.27 [‐45.15, 24.61]

2 FEV1 L: mean difference Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Discharge

1

17

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.60, 0.34]

2.2 6 weeks

1

14

Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.55, 0.69]

2.3 3 months

1

13

Mean Difference (IV, Fixed, 95% CI)

0.15 [‐0.55, 0.85]

2.4 12 months

1

8

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐1.11, 1.71]

3 Mortality Show forest plot

1

20

Odds Ratio (M‐H, Fixed, 95% CI)

5.0 [0.64, 39.06]
Figuras y tablas -
Comparison 1. Early rehab versus usual care
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Comparison 2. Expert patient programme versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 SGRQ Total: mean difference Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Post‐intervention

1

62

Mean Difference (IV, Fixed, 95% CI)

‐6.5 [‐16.59, 3.59]

1.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

‐2.60 [‐12.97, 7.77]

1.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

3.20 [‐6.64, 13.04]

2 Self‐efficacy: Exercise Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

2.10 [0.89, 3.31]

2.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.40 [0.14, 2.66]

2.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐0.46, 2.06]

3 Self‐efficacy: Disease info Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.5 [0.07, 2.93]

3.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.75 [0.38, 3.12]

3.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐0.13, 2.73]

4 Self‐efficacy: Obtain help Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.10 [0.05, 2.15]

4.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐0.34, 1.94]

4.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐0.19, 2.19]

5 Self‐efficacy: Communication Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.10 [0.14, 2.06]

5.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.90 [0.04, 1.76]

5.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐0.07, 1.87]

6 Self‐efficacy: Manage disease Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.10 [0.17, 2.03]

6.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.10 [0.27, 1.93]

6.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.70 [‐0.27, 1.67]

7 Self‐efficacy: Do chores Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

2.0 [0.78, 3.22]

7.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.20 [‐0.14, 2.54]

7.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.20 [‐0.01, 2.41]

8 Self‐efficacy: Social activity Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

2.0 [0.84, 3.16]

8.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐0.42, 2.22]

8.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.88, 1.68]

9 Self‐efficacy: Manage symptoms Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.90 [0.78, 3.02]

9.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.20 [0.13, 2.27]

9.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.70 [‐0.41, 1.81]

10 Self‐efficacy: Manage breathlessness Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

1.5 [0.32, 2.68]

10.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐0.31, 2.11]

10.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐0.36, 2.16]

11 Self‐efficacy: Manage depression Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.1 Postintervention

1

62

Mean Difference (IV, Fixed, 95% CI)

2.0 [0.91, 3.09]

11.2 3 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.40 [0.19, 2.61]

11.3 6 months

1

60

Mean Difference (IV, Fixed, 95% CI)

1.30 [0.09, 2.51]
Figuras y tablas -
Comparison 2. Expert patient programme versus usual care
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