189 6 Cochrane review on integrated disease management for COPD this review (Kruis 2013). Agreements and disagreements with other studies or reviews This review adds to the results of six earlier systematic reviews analysing IDM for COPD patients (Adams 2007; Lemmens 2009; Lemmens 2013; Niesink 2007; PeytremannBridevaux 2008; Peytremann-Bridevaux 2014). The current review brings together new trials that were not included in any of these reviews, and it provides an overview of multiple outcomes. Adams 2007 examined the e ectiveness of programmes for COPD patients, including chronic care model components, and pooled six trials including at least two components. Pooled results did not demonstrate statistically signi cant di erences on the SGRQ. Adams 2007 showed lower rates of hospitalisation and shorter length of stay in the intervention group, comparable to our results. Lemmens 2009 pooled data based on the number of components used in IDM and compared these to usual care. The e ect on the SGRQ was optimal if three components of IDM were used (MD -4.69), which is comparable to our e ect in the medium term (MD -3.89). Review authors also showed a decrease in the number of respiratory-related hospitalisations for studies with multiple intervention components, with a pooled odds ratio (OR) of 0.58, which is comparable to the OR of 0.64 found in the current review. Niesink 2007 described the results of several studies that evaluated quality of life in IDM programmes among COPD patients. Five out of 10 studies showed clinically relevant improvement in quality of life. Peytremann-Bridevaux 2008 examined the e ectiveness of IDM in COPD patients for exercise tolerance, quality of life, hospital admissions, and mortality. Only data on hospital admissions and exercise tolerance were pooled. In line with the current review, positive e ects on exercise capacity were found, but no signi cant e ects were found for hospital admissions. Review authors demonstrated mean improvement of 32 metres on the 6MWD in ve studies. Although we found overall improvement of 45 metres, this is largely attributable to the IDM programmes with a dominant exercise component. Furthermore, the pooled odds ratio of 0.85 (95% con dence interval (CI) 0.54 to 1.36) for mortality reported by review authors is comparable to that in our review (OR 0.86, 95% CI 0.59 to 1.25). Lemmens 2013 performed a meta-analysis on existing reviews that focused on IDM programmes with two or more components for adult patients with COPD. They showed statistically signi cant improvements on the SGRQ in favour of IDM (P < 0.01) with moderate heterogeneity. In contrast to our review, these review authors did not nd any signi cant changes in all-cause hospitalisations (OR 0.95, 95% CI 0.76 to 1.14) or in numbers of ED visits (OR -0.11, 95% CI -0.26 to 0.04). PeytremannBridevaux 2014 performed an additional analysis of studies in the previous version of this Cochrane systematic review, in which they speci cally assessed potential di erences in mortality between IDM and usual care. They found no e ects of IDM on mortality (OR 1.00, 95% CI 0.79 to 1.28), which is in line with our current ndings. Some of the observed di erences can be explained by the fact that nearly all reviews used di erent de nitions of IDM. Also, all aforementioned systematic reviews included study designs other than RCTs, except Peytremann-Bridevaux 2014. In addition to other reviews that assessed the e ectiveness of IDM in COPD as
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