157 6 Cochrane review on integrated disease management for COPD educational yers) are delivered to patients with COPD; therefore, classi cation would be too ambiguous, depending largely on what is reported. Hence, this review does not include di erent control groups as a subgroup analysis. Sensitivity analysis We performed sensitivity analyses on the basis of the methodological quality of studies. We did so by repeating our analysis among only studies judged to be of ‘high quality’. For the purposes of this review, ‘high-quality studies’ were de ned as studies with low or unclear risk of bias due to allocation concealment, low or unclear risk of bias due to incomplete outcome data, and, in the case of cluster-RCTs, studies with adequate analysis methods. Summary of findings and assessment of the certainty of the evidence We presented the main results of this review in a ‘Summary of ndings’ table, which includes an overall rating of the evidence using the GRADE approach, in accordance with recommendations laid out in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). This involves making separate ratings for quality of evidence for each patient-important outcome by identifying ve factors that can lower the quality of evidence, including study limitations, indirectness of evidence (also called clinical heterogeneity with regard to study population, intervention, control group, and outcomes), unexplained heterogeneity or inconsistency of results (i.e. statistical heterogeneity), imprecision of results (i.e. due to small sample sizes and few events), and high probability of publication bias. However, other factors can increase the quality of evidence; these include large magnitude of e ect; plausible confounding, which could reduce the demonstrated e ect; and the dose-response gradient (GRADE Working Group 2004). We have presented footnotes to justify decisions made and have provided comments to support readers’ understanding of this review. We intended to present short-, medium-, and long-term outcomes for all of our primary outcomes in the ‘Summary of ndings’ table. However, because we were limited to a maximum of seven outcomes, we decided to present dichotomous outcomes for all time points and continuous outcomes for medium-term follow-up only, being most clinically relevant. For all outcomes, we presented the range and the median follow-up. Results Description of studies See Characteristics of included studies. Results of the search Our literature search yielded 6900 citations after duplicates were removed with potential for inclusion (see Figure 1). We excluded 6543 citations during the initial screening of titles and abstracts and assessed full texts of 357 citations. Eleven
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