Summary of findings: intervention components seeking to improve adherence (outcome adherence reported as continuous outcomes)
| Components (versus standard care) | SMD (95% CI) | Participants (studies), n | SUCRA (p-value) | Certainty of the evidence (GRADE) | Comments |
|---|---|---|---|---|---|
| Education | 1.26 (1.13–1.38) | 859 (7 RCTs/1 observational) | 0.9043 | ⊕○○○ Very low¶,+ | Education, as a stand-alone component, may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Education+motivation | 0.83 (−1.06–2.72) | 645 (7 RCTs/1 observational) | 0.6720 | ⊕○○○ Very low¶,+,§ | The association of education and motivation may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Education+reminder+pulmonary rehabilitation | 0.81 (−1.05–2.67) | 492 (7 RCTs/1 observational) | 0.6669 | ⊕○○○ Very low¶,+,§ | The association of education, reminder and pulmonary rehabilitation may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Education+motivation+telemedicine | 0.54 (−0.09–1.17) | 516 (7 RCTs/1 observational) | 0.6171 | ⊕○○○ Very low¶,+,§ | The association of education, motivation and telemedicine may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Motivation | 1.85 (1.19–2.50) | 672 (7 RCTs/1 observational) | ⊕○○○ Very low¶,+,ƒ | Motivation, as a stand-alone component, may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# | |
| Telemedicine | 0.30 (−0.19–0.79) | 620 (7 RCTs/1 observational) | 0.5040 | ⊕○○○ Very low¶,+,ƒ | Telemedicine, as a stand-alone component, may improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Standard care | 467 (7 RCTs/1 observational) | 0.3094 | |||
| Education+psychosocial support | −0.16 (−1.30–1.98) | 560 (7 RCTs/1 observational) | 0.2832 | ⊕○○○ Very low¶,+,§ | The association of education and psychosocial support may not improve adherence compared to standard care but the evidence is very uncertain, based on the Cohen's d effect size# |
| Education+motivation+pulmonary rehabilitation | −0.70 (−0.97– −0.42) | 583 (7 RCTs/1 observational) | 0.0431 | ⊕○○○ Very low¶,+,ƒ | The association of education, motivation and pulmonary rehabilitation may not improve adherence compared to standard care, based on the Cohen's d effect size# |
Patient or population: COPD; settings: clinical, home and remote; intervention components: education, motivation, reminder, pulmonary rehabilitation, telemedicine, psychosocial support; comparison: standard care; follow-up: range 4–24 months. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) 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. SMD: standardised mean difference; SUCRA: surface under the cumulative ranking; RCT: randomised controlled trial. #: small effect 0.2, medium effect 0.5, large effect ≥0.8; ¶: 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; §: downgraded by two levels for imprecision because of the large confidence interval and the small sample size; ƒ: downgraded by one level for imprecision because of the small sample size.