186 6 Chapter 6 without clinical relevance and in dyspnoea. We found no statistically signi cant di erences between IDM and usual care in terms of generic quality of life (i.e. Short Form (SF)-12/36 score), courses of antibiotics/prednisolone, mortality, or depression and anxiety scores. Overall completeness and applicability of evidence With the addition of 26 new studies resulting from the search update for the 2020 review, the number of people with COPD in this review increased from 2997 to 21,086. The large increase in terms of studies and participants has resulted in better precision and better generalisability of ndings. In addition, we were able to distinguish short-, medium-, and long-term e ects. Unfortunately, we observed large heterogeneity within the primary analysis for almost all primary outcomes. Although part of the observed heterogeneity could probably be explained by variation in the quality of studies in some cases, our results are also marked by large clinical and methodological variations. Accordingly, the applicability of our evidence warrants some comments. The COPD population in the included studies ranged from those with mild to very severe COPD, and trials were conducted across all types of healthcare settings in a range of di erent countries, each with a unique healthcare system. This improves generalisability and makes (parts of) the results of this review applicable to a large proportion of COPD patients worldwide. However, one should bear in mind that the precise applicability will depend on the context of the speci c healthcare setting and the type of COPD patient. The IDM programmes included in this review also di ered in types of healthcare providers involved, types of intervention components, and intervention duration and intensity, re ecting the diversity of daily practice. Overall, with subgroup analysis, we noticed intervention-speci c e ects, that is, IDM programmes focused mainly on exercise probably result in greater improvement in exercise capacity, and programmes with self-management as the dominant component probably led to fewer respiratory- related hospital admissions. Besides clinical heterogeneity, our review also deals with signi cant methodological heterogeneity. We included studies with di erences in duration and intensity of followup. By dividing the follow-up duration into short-, medium-, and long-term follow-up, we aimed to assess groups of studies with su cient homogeneity. However, the intensity of the intervention could still di er between included studies. Also, it should be noted that an observed e ect at long term does not necessarily indicate a sustained e ect of the intervention because for some studies, the interventions continued throughout the study. Hence, further research is required to de ne the optimal combination, intensity, and duration of components of IDM programmes, taking into account the importance of methodological factors. Our subgroup analysis results point towards bene cial e ects among telemonitoringbased IDM interventions in terms of health-related quality of life, exercise capacity, and respiratory-related hospital admissions. However, given the small number of studies (5 studies) including telemonitoring, no decisive conclusions or recommendations can be made regarding the overall bene cial e ects of telemonitoring as an IDM programme.
RkJQdWJsaXNoZXIy MTk4NDMw