Summary of findings 1. Digital intervention with or without routine supported self‐management compared to control for the management of chronic obstructive pulmonary disease (Random‐effects model).
| Digital intervention with or without routine supported self‐management compared to control for the management of chronic obstructive pulmonary disease | |||||||
| Patient or population: the management of chronic obstructive pulmonary disease Setting: single or multi‐centred, secondary care, academic medical centres, pulmonary outpatient clinics and general practices Intervention: digital intervention with or without routine supported self‐management Comparison: control | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | ||
| Risk with control | Risk with Digital intervention with or without routine supported self‐management | ||||||
| Impact on health behaviour: 6MWD | Follow‐up: 13 weeks | The mean increase in 6MWD was 403.4 m | MD 26.2 m higher (21.7 lower to 74.1 higher) | ‐ | 122 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | MID for 6MWD for COPD is 25 metres |
| Follow‐up: 23 to 26 weeks |
The mean increase in 6MWD was 418.5 m | MD 14.31 m higher (19.41 lower to 48.03 higher) | ‐ | 164 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | MID for 6MWD for COPD is 25 metres | |
| Follow‐up: 52 weeks | The mean increase in 6MWD was 311.7 m | MD 54.33 m higher (35.47 lower to 144.12 higher) | ‐ | 204 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 4 5 | MID for 6MWD for COPD is 25 metres. MD was 66 points higher and was clinically significant. One study was causing the overall effect estimate to favour the intervention, and the heterogeneity between the studies suggests fundamental differences between both studies | |
| Self‐efficacy: PRAISE | Follow‐up: 13 weeks | The mean PRAISE score was 45.6 units | MD 2.4 units lower (7.09 lower to 2.29 higher) | ‐ | 55 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 6 | Higher is better; MID 0.5 to 1.5 (Vincent 2011; Liacos 2019) |
| Self‐efficacy: SEMCD total | Follow‐up: 52 weeks | The mean SEMCD score (total) was 6.69 units | MD 0.2 units higher (1.03 lower to 1.43 higher) | ‐ | 42 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 26 | Higher score is better (score range 10 to 40) (validated scale but no MID found) (Freund 2013) |
| Quality of life: CRQ total, SGRQ total or CAT |
Follow‐up: 13 weeks | The mean CRQ total score was 4.6 units | MD 0.45 higher (0.01 higher to 0.9 higher) | ‐ | 123 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 7 | Minor improvement in CRQ total, but the result was not clinically significant as the estimate did not reach the MID of 0.5 (Wijkstra 1994); Scale from: 20 to 140 |
| Follow‐up: 23 weeks | The mean CRQ total score was 4.82 units | MD 0.29 units higher (0.08 lower to 0.66 higher) | ‐ | 123 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | Minor improvement in CRQ total, but the result was not clinically significant as the estimate did not reach the MID of 0.5 (Wijkstra 1994) | |
| Follow‐up: 52 weeks | The mean CRQ total score 4.82 units | MD 0.42 units higher (0.07 lower to 0.91 higher) | ‐ | 84 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 2 8 | No difference in improvement of CRQ (MID 0.5) (Wijkstra 1994) | |
| Follow‐up: 52 weeks | The mean SGRQ total score was 57.9 units | MD 26.57 lower (34.09 lower to 19.05 lower) | ‐ | 120 (1 RCT) | ⊕⊕⊝⊝ LOW 3 9 | Marked improvement of SGRQ of more than 4 points (MID) (Jones 1992) | |
| Follow‐up:13 weeks | The mean CAT score was 10.1 | MD 1.8 higher (1.62 lower to 5.22 higher) | ‐ | 55 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 23 6 | MID of 10 point increase results in clinical improvement (Jones 2009; Tsiligianni 2012) | |
| Dyspnoea symptoms: CRQ dyspnoea | Follow‐up: 52 weeks | The mean CRQ dyspnoea score was 4.56 units | MD 0.64 higher (0.06 higher to 1.22 higher) | ‐ | 84 (1 RCT) | ⊕⊕⊝⊝ LOW 3 10 | Considerable improvement of symptoms on CRQ of above the MID of 0.5 (Wijkstra 1994). There is little to no difference of CRQ dyspnoea at 13 or 26 weeks follow‐up (Analysis 1.11) |
| Exacerbations: mean number of exacerbations | Follow‐up: 26 weeks | The mean number of exacerbations was 0.48 | MD 0.17 lower (0.5 lower to 0.16 higher) | ‐ | 69 (1 RCT) | ⊕⊕⊝⊝ LOW 2 3 11 | No difference in mean exacerbations |
| *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). CAT: COPD assessment test; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CRQ: Chronic Respiratory Questionnaire; MD: mean difference; MID: minimally important difference; OR: odds ratio; QOL: quality of life; RCT: randomised controlled trial; RR: risk ratio; 6MWD: six‐minute walk distance; 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. | |||||||
1 Downgraded two levels for limitations due to high risk of bias (allocation concealment, performance, detection and selective reporting bias)
2 Downgraded one level for imprecision; the confidence intervals were wide and crossed the line of no effect
3 Downgraded one level; optimal information size not met (total number of participants was less than 200)
4 Downgraded by two levels for inconsistency; heterogeneity was 95%
5 Not downgraded for indirectness; interventions, settings and geographical location different but met the inclusion criteria
6 Downgraded by two levels for limitations due to risk of bias (performance and detection bias)
7 Downgraded one level for inconsistency; heterogeneity was 34%
8 Downgraded one level for limitations due to risk of bias (performance, attrition, and selective reporting bias)
9 Downgraded two levels for limitations due to high risk of bias (performance, detection and attrition bias)
10 Downgraded two levels for limitations due to high risk of bias (allocation concealment, performance and selective reporting bias)
11 Downgraded one level for limitations due to risk of bias (performance bias)