Summary of findings table for intervention components seeking to improve the HRQoL reported with the SGRQ (total score)
| Components (versus standard care) | MD (95% CI) | Participants (studies), n | SUCRA (p-value) | Certainty of the evidence (GRADE) | Comments |
|---|---|---|---|---|---|
| Motivation | −13.01 (−20.83– −5.18) | 450 (6 RCTs) | 0.9533 | ⊕○○ Very low#,¶,+,§ | Motivation, as a stand-alone component, may improve the HRQoL measured with the SGRQ compared to standard care but the evidence is very uncertain, considering an MCID of −4 units |
| Education | −9.70 (−10.82– −8.57) | 537 (6 RCTs) | 0.8405 | ⊕⊕○○ Low#,¶,+,ƒ | Education, as a stand-alone component, may result in a large increase in the HRQoL measured with the SGRQ compared to standard care, considering an MCID of −4 units |
| Education+motivation | −4.12 (−7.72– −0.52) | 551 (6 RCTs) | 0.5752 | ⊕○○○ Very low#,¶,## | The association of education and motivation may improve the HRQoL measured with the SGRQ compared to standard care but the evidence is very uncertain, considering an MCID of −4 units |
| Standard care | 423 (6 RCTs) | 0.2621 | |||
| Telemedicine | 0.90 (−3.70–5.50) | 528 (6 RCTs) | 0.1888 | ⊕○○○ Very low#,¶,¶¶ | Telemedicine, as a stand-alone component, may not improve the HRQoL measured with the SGRQ compared to standard care but the evidence is very uncertain, considering an MCID of −4 units |
| Education+psychosocial support | 1.40 (−5.79–8.59) | 521 (6 RCTs) | 0.1801 | ⊕○○○ Very low#,¶,++ | The association of education and psychosocial support may not improve the HRQoL measured with the SGRQ compared to standard care but the evidence is very uncertain, considering an MCID of −4 units |
Patient or population: COPD; settings: clinical (inpatient and outpatient) and home; intervention components: education, motivation, telemedicine, psychosocial support; comparison: standard care; follow-up: range 6–12 months. The GRADE Working Group grades of evidence are as follows. 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. HRQoL: health-related quality of life; SGRQ: St George's Respiratory Questionnaire; MD: mean difference; SUCRA: surface under the cumulative ranking; RCT: randomised controlled trial; MCID: minimal clinically important difference. #: downgraded by two levels for risk of bias because all the evidence is from studies at high risk of bias and some concern, and no study is at low risk of bias; ¶: downgraded by one level for inconsistency because of some variations in the direction of the effects; +: upgraded by one level due to the large effect; §: downgraded by two levels for imprecision because the 95% CI crosses the thresholds of moderate and large effect (based on an MCID of −4 units); ƒ: downgraded by one level for imprecision because of the small sample size (<800 participants, rule of thumb based on the Cohen's small effect size); ##: downgraded by one level for imprecision because the 95% CI crosses the threshold of small effect (based on an MCID of −4 units); ¶¶: downgraded by one level for imprecision because the 95% CI crosses the threshold of small harm (based on an MCID of −4 units); ++: downgraded by two levels for imprecision because the 95% CI crosses the thresholds of small harm and benefit (based on an MCID of −4 units).