Table A9: GRADE Evidence Profile for Comparison of Self-Management and Usual Care (Health Care Utilization Outcomes).
| No. of Studies (Design) | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | Upgrade Considerations | Quality |
|---|---|---|---|---|---|---|---|
| Visits with General Practitioners | |||||||
| 7 (RCTs) (4;12;14-17;19) | Very serious limitations (−2)a | No serious limitations | Serious limitations (−1)b | Serious limitations (−1)c | Undetected | None | ⊕ Very Low |
| Visits to the Emergency Department | |||||||
| 5 (RCTs) (4;14−17) | Very serious limitations (−2)a | Serious limitations (−1)d | Serious limitations (−1)b | Serious limitations (−1)c | Undetected | None | ⊕ Very Low |
| Days in Hospital | |||||||
| 5 (RCTs) (4;12;14;15;17) | Very serious limitations (−2)a | No serious limitations | Serious limitations (−1)b | Serious limitations (−1)c | Undetected | None | ⊕ Very Low |
| Hospitalizations | |||||||
| 3 (RCTs) (4;10;17) | Very serious limitations (−2)a | No serious limitations | Serious limitations (−1)b | Serious limitations (−1)c | Undetected | None | ⊕ Very Low |
Abbreviations: ITT, intention-to-treat; RCT, randomized controlled trial.
a
Included trials suffered from lack of allocation concealment and blinding (recent evidence suggests that bias associated with lack of blinding and lack of concealment may be greater in trials with subjective outcomes such as patient-reported outcomes) (31) and lack of appropriate ITT analysis (see Table A9).
b
Outcomes of health care utilization were obtained from self-report and not from direct patient records or administrative databases.
c
Confidence intervals around estimates include the null values.
d
Findings from 1 trial were in opposite direction to other included trials; see Figure A14.