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.