167 6 Cochrane review on integrated disease management for COPD E ects of interventions Primary outcomes 1. Quality of life Of the 52 studies included, 46 studies measured quality of life, that is, health-related quality of life (34 studies), generic quality of life (four studies), or both (eight studies). In total, 11 di erent instruments were used (see Table 3). Health-related quality of life 1. St. George’s Respiratory Questionnaire (SGRQ) (25 studies) 2. Chronic Respiratory Questionnaire (CRQ) (nine studies) 3. Clinical COPD Questionnaire (CCQ) (three studies) 4. COPD Assessment test (CAT) (six studies) 5. Body mass index (BMI), air ow obstruction, dyspnoea, and exercise capacity index (BODE) (six studies) 6. Barthel score (one study) 7. Dartmouth Primary Care Co-operative Quality of Life Questionnaire (COOP) (one study) Generic quality of life 1. Short Form-36 (SF-36) or Short Form-12 (SF-12) (eight studies) 2. EQ-5D (four studies) 3. Sickness Impact Pro le (SIP) (two studies) 4. York Quality of Life Questionnaire (YGLQ) (one study) We performed a meta-analysis combining the results of some or all of these questionnaires. The SGRQ and the CRQ are respiratory-speci c quality of life questionnaires and have become the recognised standards of HRQoL assessment amongst patients with COPD. However, pooling of these instruments into a metaanalysis was impossible, as the CRQ is more responsive than the SGRQ (Puhan 2006). Furthermore, the included generic quality of life questionnaires (SF-36, SIP, and COOP) measure other dimensions of generic quality of life; therefore combining these data in a meta-analysis across tools is not recommended. 1.1. SGRQ total score (medium-term) Eighteen studies with a total population of 4321 participants provided data on the SGRQ total score with follow-up between 6 and 15 months (Bourbeau 2003; Boxall 2005; Engstrom 1999; Fan 2012; Fernandez 2009; Gottlieb 2011; Jimenez-Reguera 2020; Kalter-Leibovici 2018; Ko 2016; Kruis 2014; Rice 2010; Rose 2017; Titova 2017; Vasilopoulou 2017; Wakabayashi 2011; Wang 2017; Wood-Baker 2006; Zwar 2016). Kessler 2018 used a COPD-speci c SGRQ, which could not be pooled. The pooled MD
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