171 6 Cochrane review on integrated disease management for COPD pooled e ects did not show a statistically signi cant long-term di erence between both groups (Analysis 1.3). 1.6. CRQ domain scores - short-term The Chronic Respiratory Disease Questionnaire (CRQ), with a scale from 0 to 7 and MCID of 0.5, was reported in nine studies (Bendstrup 1997; Cambach 1997; Farrero 2001; Güell 2000; Güell 2006; Lenferink 2019; Rea 2004; Sridhar 2008; Wijkstra 1994). Farrero 2001 administered the CRQ only to the rst 40 consecutive patients, and therefore outcomes were not published. Bendstrup 1997 and Rea 2004 reported insu cient data to compute an estimation of e ect and therefore were not included in the meta-analysis. Wijkstra 1994 did not report on the dyspnoea dimension of the CRQ and compared two IDM interventions with usual care. We included both study arms in the meta-analysis. Pooled results for the CRQ up to 6 months included 277 participants for the CRQ Dyspnea dimension and 314 for the other domains. There was no statistically signi cant di erence between IDM and control for any dimension (Analysis 1.8). Heterogeneity was substantial for all dimensions (I² between 72% and 86%). Sensitivity analysis for CRQ Dyspnoea was not performed, as this would include only one high-quality study. Sensitivity analysis for the other CRQ dimensions did not change the results but smaller heterogeneity was observed (I² between 0% and 35%). Thus, heterogeneity could be explained in part by the quality of the studies (see Table 7). 1.7. CRQ domain scores - medium-term Three of the four studies that reported CRQ up to 6 months also reported CRQ outcomes after 6 months (Güell 2000; Lenferink 2019; Wijkstra 1994). Pooled results, including 2 studies and 219 participants for the CRQ dyspnoea dimension, showed no statistically signi cant di erences between IDM and control groups (MD 0.29, 95% CI -0.88 to 1.46). There also were no statistically signi cant di erences between groups for the CRQ fatigue domain (MD 0.37, 95% CI -0.53 to 1.26), the CRQ emotion domain (MD 0.36, 95% CI -0.84 to 1.57), and the CRQ mastery domain (MD 0.76, 95% CI -0.41 to 1.94) (Analysis 1.9). 1.8. CRQ domain scores - long-term Three studies reported on long-term e ects on the CRQ at 24 months’ follow-up, with a total of 184 participants (Güell 2000; Sridhar 2008; Wijkstra 1994) (Analysis 1.10). Pooled data showed no di erences between groups on the CRQ dyspnoea domain (MD 0.47, 95% CI -0.31 to 1.25). In contrast, pooled data on the CRQ fatigue domain showed a statistically signi cant di erence in favour of IDM (MD 0.46, 95% CI 0.06 to 0.85). Also, a signi cant di erence in favour of IDM was observed for CRQ emotion (MD 0.53, 95% CI 0.10 to 0.95) and CRQ mastery (MD 0.83, 95% CI 0.41 to 1.26). With an MCID of 0.5, the di erences were also clinically signi cant. Sensitivity analysis revealed that when Güell 2000 was excluded due to inadequate concealment of allocation, pooled di erences on CRQ fatigue, emotion, and mastery remained in favour of IDM; however CRQ fatigue was not statistically signi cant (MD 0.42, 95% CI -0.05 to 0.89) (Table 7).
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