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Table 2 GRADE Evidence Profile

From: Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis

Supervised early PR versus usual care for patients with acute exacerbation of COPD
Outcome Timeframe Study results and measurements Absolute effect estimates Certainty in the effects estimates (Quality of evidence) Plain text summary
Usual care Early PR
Mortality
End of treatment
Critical
Relative risk 0.58
(CI 95% 0.35–0.98)
Based on data from 319 patients (4 studies)
173
per 1.000
100
per 1.000
Moderate
Due to serious risk of biasa
Early pulmonary rehabilitation probably decreases mortality at the end of treatment
Difference: 73 fewer per 1.000
(CI 95% 112 fewer - 3 fewer)
Mortality
Longest follow-up
Critical
Relative risk 0.55
(CI 95% 0.12–2.57)
Based on data from 127 patients (3 studies)
63
per 1.000
35
per 1.000
Low
Due to serious risk of biasand serious risk of imprecisiona,b
Early pulmonary rehabilitation may decrease mortality slightly at the longest follow-up
Difference: 28 fewer per 1.000
(CI 95% 55 fewer - 99 more)
Days in hospital
End of treatment
Important
Measured by: Days
Lower is better
Based on data from 180 patients (1 study)
0.86
(mean)
4.59
(mean)
Moderate
Due to serious imprecisionc
Early pulmonary rehabilitation probably decreases days in hospital at the end of treatment
Difference: MD 4.27 lower
(CI 95% 6.85 lower - 1.69 lower)
Days in hospital
Longest follow-up
Important
    No studies were found that looked at number of days in hospital at the longest follow-up
Readmission due to exacerbation
End of treatment
Important
    No studies were found that looked at readmission to hospital due to exacerbation at the end of treatment
Readmission due to exacerbation
Longest follow-up
Important
Rate ratio 0.47
(CI 95% 0.29–0.75)
Based on data from 365 patients (6 studies)
  Moderate
Due to serious risk of biasa,d
Early pulmonary rehabilitation probably decreases readmission to hospital due to exacerbation at the longest follow-up
Health-related quality of life
End of treatment
Important
Measured by: SGRQ
Lower is better
Based on data from 86 patients (2 studies)
Difference: MD 19.43 lower
(CI 95% 29.09 lower - 9.77 lower)
Low
Due to serious risk of bias and serious risk of imprecisiona,c
Early pulmonary rehabilitation may improve health-related quality of life at the end of treatment
Health-related quality of life
Longest follow-up
Important
Measured by: SGRQ
Lower is better
Based on data from 323 patients (4 studies)
Difference: MD 8.74 lower
(CI 95% 12.02 lower - 5.45 lower)
Moderate
Due to serious risk of biasa,d
Early pulmonary rehabilitation probably improves health-related quality of life at the longest follow-up
Exercise capacity
End of treatment
Important
Measured by: SWT (meters)
Higher is better
Based on data from 95 patients (3 studies)
Difference: MD 54.7 more
(CI 95% 30.83 more - 78.57 more)
Moderate
Due to serious risk of biasa,d
Early pulmonary rehabilitation probably increases exercise capacity at the end of treatment
Exercise capacity
End of treatment
Important
Measured by: 6MWT (meters)
Higher is better
Based on data from 274 patients (5 studies
Difference: MD 76.89 more
(CI 95% 21.34 more - 132.45 more)
Low
Due to serious risk of bias and serious inconsistencya,d,e
Early pulmonary rehabilitation probably increases exercise capacity at the end of treatment
Exercise capacity
Longest follow-up
Important
Measured by: SWT (meters)
Higher is better
Based on data from 2017 patients (3 studies)
Difference: MD 90.27 higher
(CI 95% 69.53 lower - 250.08 higher)
Low
Due to serious risk of bias and serious inconsistency leading to serious imprecisiona,b,d,e
Early pulmonary rehabilitation may increase exercise capacity at the longest follow-up
Dropout rate
End of treatment
Important
Relative risk 0.99
(CI 95% 0.71–1.39)
Based on data from 440 patients (8 studies)
217
per 1.000
215
per 1.000
Moderate
Due to serious risk of biasa,d
Early pulmonary rehabilitation probably has little impact on the dropout rate at the end of treatment
Difference: 2 fewer per 1.000
(CI 95% 63 fewer - 85 more)
Dropout rate
Longest follow-up
Important
Relative risk 1.05
(CI 95% 0.6–1.85)
Based on data from 181 patients (3 studies)
202
per 1.000
212
per 1.000
Moderate
Due to serious risk of biasa,d
Early pulmonary rehabilitation probably has little impact on dropout at the longest follow-up
Difference: 10 more per 1.000
(CI 95% 81 fewer - 172 more)
Falls
Longest follow-up
Important
    No studies were found that looked at falls at the longest follow-up
Activities of daily living
End of treatment
Important
    No studies were found that looked at activities of daily living at the end of treatment
Activities of daily living
Longest-follow-up
Important
    No studies were found that looked at activities of daily living at the longest follow-up
  1. CI confidence interval, COPD chronic obstructive pulmonary disease, MD middle difference, PR pulmonary rehabilitation, SGRQ St. George’s Respiratory Questionnaire, SWT Shuttle Walking Test, 6MWT 6 min walking test
  2. Quality of evidence. High quality: We are very confident that the true effect lies close to that of the estimate of the effect; Moderate quality: We are moderately confident in the effect estimate, the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low quality: Our confidence in the effect estimate is limited, the true effect may be substantially different from the estimate of the effect
  3. aRisk of bias: Serious. Unclear/inadequate sequence generation and unclear/inadequate concealment of allocation during randomization process resulting in potential for selection bias
  4. bRisk of imprecision: Serious. Wide confidence intervals
  5. cRisk of imprecision: Serious. Low number of patients
  6. dRisk of bias: Serious. Inadequate/unclear or lack of blinding of outcome assessors resulting in potential for detection bias
  7. eRisk of inconsistency: Serious. The magnitude of statistical heterogeneity was high