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