190 6 Chapter 6 described above, multiple systematic reviews have assessed the e ectiveness of di erent components of IDM programmes. Exercise Two Cochrane Reviews examined pulmonary rehabilitation programmes for COPD patients in which the dominant component is generally exercise training. McCarthy 2015 assessed the e ectiveness of pulmonary rehabilitation for COPD in general, although Puhan 2016 speci cally assessed the e ectiveness of pulmonary rehabilitation following an exacerbation of COPD. Similar to our review, McCarthy 2015 demonstrated statistically signi cant improvement in quality of life and exercise capacity (6MWD) in favour of pulmonary rehabilitation (SGRQ overall score MD -6.89; 6MWD MD 43.93 metres). Only one study in our review, Ko 2016, is also included in Puhan 2016, probably because of its selection of COPD patients with a recent exacerbation. The review authors also showed signi cant improvement in quality of life and exercise capacity in favour of pulmonary rehabilitation (SGRQ MD 7.80; 6MWD MD 62 metres) and a reduction in hospital admissions (OR 0.44). Telemonitoring The e ectiveness of telemonitoring among COPD patients was assessed in a systematic review and meta-analysis of 27 studies (Hong 2019). In contrast to results from our subgroup analysis with telemonitoring as the dominant component, Hong 2019 found no di erence in SGRQ (MD -0.21; our review MD -18.33) or in hospitalisations (all- cause and respiratory-related). However, our analyses are based on a small number of studies, which makes it impossible to draw rm conclusions. Another recent systematic literature review showed inconclusive results for the e ectiveness of telemonitoring in COPD (Kruse 2019). These review authors did not perform a meta-analysis but described 29 articles, of which 13 (45%) showed favourable results, ve (17%) negative outcomes, and 11 (38%) no di erences in outcomes. Self-management Two Cochrane systematic reviews reported on self-management-based interventions in COPD. Zwerink 2014 assessed self-management training, which should allow patients to successfully manage their own disease. Follow-up ranged between 2 and 24 months. Lenferink 2017 focused on self-management interventions that are personalised and included action plans for the management of exacerbations. In line with our results, both reviews found signi cant improvement in HRQoL in favour of the intervention (Zwerink 2014 SGRQ overall score MD -3.51; Lenferink 2017 MD -2.69). In these reviews, respiratory-related hospital admissions were assessed as the number of people with at least one respiratory-related hospital admission. Still, both studies showed similar signi cantly reduced risk in favour of the intervention (Zwerink 2014 OR 0.57; Lenferink 2017 OR 0.69). It is interesting to note that in our review, we did not nd a di erence in the number of people prescribed at least one course of oral corticosteroids (OR 1.05), whereas in both of the other reviews, odds ratios appeared to be much higher in the intervention group, albeit with non-statistically signi cant
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