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/></a></div><div class="bkr_bib"><h1 id="_NBK612147_"><span itemprop="name">Evidence reviews for symptom diary for monitoring asthma</span></h1><div class="subtitle">Asthma: diagnosis, monitoring and chronic asthma management (update)</div><p><b>Evidence review L</b></p><p><i>NICE Guideline, No. 245</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-6625-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng245er12.s1"><h2 id="_niceng245er12_s1_">1. Symptom diary</h2><div id="niceng245er12.s1.1"><h3>1.1. Review question</h3><p>In people with asthma, what is the clinical and cost-effectiveness of using symptom scores/diaries or validated questionnaires measuring symptom control (e.g. ACT, ACQ, CACT, RCP 3 questions) and/or health related quality of life (e.g. AQLQ, PAQLQ) to monitor asthma?</p><div id="niceng245er12.s1.1.1"><h4>1.1.1. Introduction</h4><p>Asthma is, characteristically, a disease which varies over time – people have some days which are worse than others. A symptom diary can be used to help people with asthma monitor how they are on particular days with regard to their symptoms and medication use and help identify any triggers for these. If people are asked to spend time doing these, and if decisions are made based on what is recorded in a diary, it is important to understand the evidence around whether they are effective.</p></div><div id="niceng245er12.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng245er12.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab1"><a href="/books/NBK612147/table/niceng245er12.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng245er12tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab1"><a href="/books/NBK612147/table/niceng245er12.tab1/?report=objectonly" target="object" rid-ob="figobniceng245er12tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng245er12.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng245er12.appa">appendix A</a> and the <a href="/books/NBK612147/bin/NG245-methods.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng245er12.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng245er12.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Seven randomised controlled studies (reported in 8 papers) were included in the review (<a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys, et al., 2008</a>, <a class="bibr" href="#niceng245er12.ref3" rid="niceng245er12.ref3">Pool, et al., 2017</a>, <a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers-Mutsaerts, et al., 2012</a>, <a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">van den Wijngaart, et al., 2017</a>, <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer, et al., 2009</a>, <a class="bibr" href="#niceng245er12.ref7" rid="niceng245er12.ref7">van Gaalen, et al., 2013</a>, <a class="bibr" href="#niceng245er12.ref8" rid="niceng245er12.ref8">Ye, et al., 2021</a>, <a class="bibr" href="#niceng245er12.ref9" rid="niceng245er12.ref9">Zhang, et al., 2020</a>); these are summarised in <a href="/books/NBK612147/table/niceng245er12.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er12tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a href="/books/NBK612147/table/niceng245er12.tab3/?report=objectonly" target="object" rid-ob="figobniceng245er12tab3">Table 3</a>).</p><p>5 studies were conducted in adults (<a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys 2008</a>; <a class="bibr" href="#niceng245er12.ref3" rid="niceng245er12.ref3">Pool 2017</a>; <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer 2009</a>; <a class="bibr" href="#niceng245er12.ref7" rid="niceng245er12.ref7">van Gaalen 2013</a>; <a class="bibr" href="#niceng245er12.ref8" rid="niceng245er12.ref8">Ye 2021</a>; <a class="bibr" href="#niceng245er12.ref9" rid="niceng245er12.ref9">Zhang 2020</a>) and 2 studies were conducted in children and young people (<a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers 2012</a>;; <a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">van Wijngaart 2017</a>). Of these studies, 4 were newly identified, since the NICE guideline (Asthma: diagnosis, monitoring and chronic asthma management) published in 2017.</p><p>A wide range of interventions were used by the 7 studies, and for some studies the intervention involved monitoring by symptoms and/or questionnaire as well as other intervention components; most notably education. Of the 5 studies in adults, studies by <a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys 2008</a> and <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer 2009</a> (and <a class="bibr" href="#niceng245er12.ref7" rid="niceng245er12.ref7">van Gaalen 2013</a>) used interventions that included educational components (in intervention arm only) as well as monitoring. Both studies in children and young people (the <a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers 2012</a> and <a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">van der Wijngaart 2017</a> studies) used interventions that included educational components (in intervention arm only) as well as monitoring.</p><p>The most common symptom control questionnaire used in the interventions was the asthma control test (ACT) and its paediatric version C-ACT (<a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys 2008</a>; <a class="bibr" href="#niceng245er12.ref8" rid="niceng245er12.ref8">Ye 2021</a>; <a class="bibr" href="#niceng245er12.ref9" rid="niceng245er12.ref9">Zhang 2020</a>; <a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">van Wijngaart 2017</a>), followed by the asthma control questionnaire (ACQ) (<a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers 2012</a>; <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer 2009</a>). <a class="bibr" href="#niceng245er12.ref3" rid="niceng245er12.ref3">Pool 2017</a> used an unvalidated questionnaire focusing on asthma symptoms.</p><p>The route by which asthma management or therapy changed in response to questionnaire monitoring varied widely from studies where there was clear involvement of a healthcare professional reviewing the questionnaires and adjusting treatment, to use of algorithms to prompt participants to alter self-management behaviours. Studies were excluded if it was not clear that management or therapy had changed in response to questionnaire monitoring. Due to the wide variability in nature of the interventions, the studies were not pooled in this review.</p><p>See also the study selection flow chart in <a href="#niceng245er12.appc">Appendix C</a>, study evidence tables in <a href="#niceng245er12.appd">Appendix D</a>, forest plots in <a href="#niceng245er12.appe">Appendix E</a> and GRADE tables in <a href="#niceng245er12.appf">Appendix F</a>.</p></div><div id="niceng245er12.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng245er12.appi">Appendix I</a>.</p></div></div><div id="niceng245er12.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab2"><a href="/books/NBK612147/table/niceng245er12.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng245er12tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab2"><a href="/books/NBK612147/table/niceng245er12.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er12tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng245er12.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng245er12.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab3"><a href="/books/NBK612147/table/niceng245er12.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng245er12tab3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab3"><a href="/books/NBK612147/table/niceng245er12.tab3/?report=objectonly" target="object" rid-ob="figobniceng245er12tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Symptom/control questionnaires (ACT monitoring with pharmacist advice based on ACT score, plus education) vs usual care (by pharmacists) in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab4"><a href="/books/NBK612147/table/niceng245er12.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img" rid-ob="figobniceng245er12tab4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab4"><a href="/books/NBK612147/table/niceng245er12.tab4/?report=objectonly" target="object" rid-ob="figobniceng245er12tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Symptom/control questionnaires (ACT-guided treatment) vs usual care (physician’s judgment) in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab5"><a href="/books/NBK612147/table/niceng245er12.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img" rid-ob="figobniceng245er12tab5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab5"><a href="/books/NBK612147/table/niceng245er12.tab5/?report=objectonly" target="object" rid-ob="figobniceng245er12tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Symptom control/questionnaires (ACT monitoring with results sent to physician)) vs usual care (ICS/LABA & education) in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab6"><a href="/books/NBK612147/table/niceng245er12.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img" rid-ob="figobniceng245er12tab6"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab6"><a href="/books/NBK612147/table/niceng245er12.tab6/?report=objectonly" target="object" rid-ob="figobniceng245er12tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Symptom control/questionnaires (ACQ monitoring with feedback to support self-management, plus education) vs usual care (Dutch guidelines) in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab7"><a href="/books/NBK612147/table/niceng245er12.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img" rid-ob="figobniceng245er12tab7"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab7"><a href="/books/NBK612147/table/niceng245er12.tab7/?report=objectonly" target="object" rid-ob="figobniceng245er12tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Symptom scores or diaries (symptom questions with feedback to support self-management) vs control questions and feedback in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab8"><a href="/books/NBK612147/table/niceng245er12.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img" rid-ob="figobniceng245er12tab8"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab8"><a href="/books/NBK612147/table/niceng245er12.tab8/?report=objectonly" target="object" rid-ob="figobniceng245er12tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary Symptom/control questionnaires (ACQ monitoring with feedback to support self-management, plus education) compared to usual care (Dutch guidelines) in children and young people. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12tab9"><a href="/books/NBK612147/table/niceng245er12.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img" rid-ob="figobniceng245er12tab9"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.tab9"><a href="/books/NBK612147/table/niceng245er12.tab9/?report=objectonly" target="object" rid-ob="figobniceng245er12tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary Symptom/control questionnaires (C-ACT monitoring with feedback to support self-management, plus education) vs usual care in children and young people. </p></div></div><p>See <a href="#niceng245er12.appf">Appendix F</a> for full GRADE tables.</p></div><div id="niceng245er12.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng245er12.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng245er12.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng245er12.appg">Appendix G</a>.</p></div></div><div id="niceng245er12.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>None.</p></div><div id="niceng245er12.s1.1.9"><h4>1.1.9. Economic model</h4><p>This area was not prioritised for new cost-effectiveness analysis.</p></div><div id="niceng245er12.s1.1.10"><h4>1.1.10. Evidence statements</h4><div id="niceng245er12.s1.1.10.1"><h5>1.1.10.1. Economic</h5><ul><li id="niceng245er12.lt1" class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div></div><div id="niceng245er12.s1.2"><h3>1.2. The committee's discussion and interpretation of the evidence</h3><div id="niceng245er12.s1.2.1"><h4>1.2.1. The outcomes that matter most</h4><p>The Committee considered the outcomes of mortality, unscheduled healthcare utilisation, asthma exacerbations, asthma control, quality of life, lung function, symptoms, dose of regular asthma therapy/preventer medication, reliever/rescue medication use and time off school or work. For the purposes of decision making, all outcomes were considered equally important and were rated as critical.</p><p>For this review there was no outcome data for mortality, time off school or work or asthma control based on the Royal College of Physicians (RCP) 3 questions questionnaire.</p><p>Asthma exacerbations were defined in the protocol as exacerbations requiring oral corticosteroid use. Definitions for exacerbations varied across studies: <a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys (2008)</a> and <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer (2009)</a> defined exacerbations as severe exacerbations requiring treatment with oral glucocorticoids or an emergency department visit or hospital admission due to asthma. <a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers (2012)</a> defined exacerbations as deterioration in asthma that required oral steroids for 3 days or more as reported in 3-monthly questionnaires. <a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">Van den Wijngaart et al (2017)</a> defined asthma exacerbations as exacerbations treated with systemic corticosteroids. <a class="bibr" href="#niceng245er12.ref8" rid="niceng245er12.ref8">Ye et al (2021)</a> did not report a definition for moderate/severe exacerbations.</p><p>Asthma control or quality of life measured by questionnaire [for example Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ) and Paediatric Asthma Quality of Life Questionnaire (PAQLQ)] are preferably reported as continuous outcomes, in line with the review protocol.</p><p>Some outcomes were identified in the review that were related to, but not identical to, those pre-specified in the protocol, and have therefore been downgraded due to indirectness of the outcome: number of asthma medications; number of asthma controller medications.</p></div><div id="niceng245er12.s1.2.2"><h4>1.2.2. The quality of the evidence</h4><p>No evidence was found in children aged 1–5 years old.</p><p>Using GRADE criteria, the quality of the evidence for most outcomes in adults was low or very low. Evidence was downgraded due to risk of bias (including risk of selection bias, lack of details on randomisation and imbalance in characteristics at baseline, unclear information on missing data and issues with analyses) and indirectness of the intervention (the intervention included education as well as monitoring by symptom diary/questionnaire). This evidence was further downgraded due to imprecision when the confidence intervals around the effect estimate crossed MIDs (minimal clinically important differences).</p><p>Evidence for three outcomes (number of emergency room visits; number of outpatient visits and ACT) from <a class="bibr" href="#niceng245er12.ref3" rid="niceng245er12.ref3">Pool et al (2017)</a> was moderate in certainty; this study was at low risk of bias but was downgraded due to indirectness of intervention. An unvalidated asthma symptom questionnaire was used that included questions on asthma care as well as symptoms. Two outcomes (number of asthma medications and number of asthma controller medications) were further downgraded due to indirectness of outcomes (these were related, but not identical to, outcomes specified in the review protocol) and were therefore graded as being of low certainty.</p><p>Using GRADE criteria, the quality of the evidence for all outcomes in children and young people was very low. This is because all included studies in children were at very high risk of bias. Issues included: lack of blinding and outcomes self-reported; unbalanced missing data across trial arms; use of a dichotomous outcome instead of a continuous outcome and lack of information reported on pre-specified analyses. Evidence was further downgraded due to indirectness of the intervention (which also included education as well as symptom diary/questionnaire monitoring) and outcome (when symptom-free days were calculated from the Childhood Asthma Control Test, (C)ACT). Several outcomes were further downgraded due to imprecision when the confidence intervals around the effect estimate crossed MIDs.</p><p>The potential bias and widespread uncertainty in the evidence, for both children and young people, and adults, influenced the Committee’s view of the evidence. They considered there to be insufficient evidence to support a strong statement on the use of symptom diaries/questionnaires for monitoring of asthma. The wide variability in route by which asthma therapy/management was adjusted in response to symptom diaries/questionnaires in the trial interventions (ranging from healthcare professionals directly adjustment treatment to use of algorithms to direct self-management) was an additional concern. The committee also noted that, although the studies generally used validated questionnaires which will reliably reflect asthma control, the action points for adjusting treatment in response to questionnaire results were not validated.</p></div><div id="niceng245er12.s1.2.3"><h4>1.2.3. Benefits and harms</h4><p>When assessing the clinically significant impact of the evidence, the GC agreed an approach for use of MIDs. For continuous outcomes, published MIDs were applied for ACT (3); (C)ACT (2); ACQ (0.5); AQLQ (0.5); and FEV1 (L) (0.23). In the absence of published MIDs, default calculations for MID were applied based on baseline SD (where available), for the rest of the continuous outcomes. For dichotomous outcomes, a threshold of 100/1000 people for changes in absolute effects was applied when assessing unscheduled visits to outpatients. A threshold of 30/1000 people for changes in absolute effects was applied when assessing the following outcomes: asthma exacerbations; emergency department visits; and hospital admissions. This is because the committee considered small differences between the intervention and comparison groups likely to be important for these outcomes.</p><p>As the study interventions varied widely, and a number were downgraded due to indirectness, no pooling of studies was conducted; assessment of each outcome was therefore based on a single RCT.</p><div id="niceng245er12.s1.2.3.1"><h5>Evidence in adults</h5><p>Evidence from one RCT showed there was no clinically important difference of ACT-monitoring (plus education) compared to usual care in adults in terms of asthma control (ACT), quality of life (AQLQ), rescue medication use; lung function (morning PEF % predicted) or asthma exacerbations (severe exacerbations). However, this RCT, which involved asthma-management advice delivered by a pharmacist based on ACT score, showed a clinically important benefit in unscheduled healthcare utilisation (emergency room visits or hospitalisation) for those who received the intervention.</p><p>Evidence from one RCT showed there was no clinically important difference of ACT guided treatment compared to usual care in terms of asthma exacerbations, asthma control (ACT), lung function (FEV1% predicted) or quality of life (AQLQ) in adults.</p><p>Evidence from one RCT showed a clinically important benefit of ACT monitoring compared to usual care for lung function (FEV1 % predicted and PEF % predicted) in adults.</p><p>Similarly, another RCT showed a clinically important benefit of ACQ monitoring (plus education) compared to usual care for lung function (FEV1 L). However, this RCT also showed no clinically important difference for a range of outcomes: asthma exacerbations; asthma control (ACQ); quality of life (AQLQ); symptoms (symptom-free days); and dose of regular asthma therapy/preventer medication (ICS) use.</p><p>Where there was evidence of clinically important benefit in adults, it was predominantly for objective outcomes on lung function in two RCTs, but the certainty of the evidence was very low. However, one further RCT provided moderate certainty evidence for a comparison of online symptom monitoring versus usual care and reported no clinically importance differences in a wide range outcomes [unscheduled healthcare utilisation (number of visits to emergency room, number of outpatient visits)] asthma control (ACT), dose of regular asthma therapy/preventer medication (number of asthma medications and number of asthma controller medications)].</p><p>Overall, the Committee considered the relatively small number of clinically important benefits identified in adults, together with concerns over the quality of the evidence, did not support regular monitoring with symptom questionnaires at the frequencies used in the studies.</p></div><div id="niceng245er12.s1.2.3.2"><h5>Evidence in children and young people</h5><p>Evidence from children and young people showed no clinically important benefit of asthma symptom/questionnaire monitoring for the outcomes included.</p><p>One RCT showed no clinically important difference of ACQ monitoring (plus education) compared to usual care for asthma exacerbations, asthma control (ACQ), quality of life (paediatric AQLQ), dose of regular asthma therapy/preventer medication (ICS dose) and symptoms (symptom-free days).</p><p>Evidence from one RCT reported on (C)ACT monitoring (plus education) compared to usual care and showed no clinically important difference for unscheduled healthcare utilisation (emergency department visits and hospital admissions) and) asthma exacerbations, lung function (FEV1 % predicted), asthma control [ACT or (C)ACT], or symptoms (symptom-free days). There was a clinically important difference favouring usual care for unscheduled healthcare utilisation (visits to outpatients).</p><p>Overall, the Committee considered the evidence-base in children and young people to be to be very limited. They noted the lack of clinically important difference in outcomes, the small number of studies available and the concerns about the certainty in the evidence.</p></div></div><div id="niceng245er12.s1.2.4"><h4>1.2.4. Cost effectiveness and resource use</h4><p>No relevant published health economic analyses were identified for this review. The committee made a recommendation to use a validated questionnaire to assess asthma control in annual reviews. Asthma control questionnaires are already recommended as part of annual reviews for asthma, so no change in practice or additional resource use is anticipated.</p></div><div id="niceng245er12.s1.2.5"><h4>1.2.5. Other factors the committee took into account</h4><p>The Committee discussed the different contexts in which monitoring of asthma control by symptoms/questionnaire could take place, namely in a clinical setting (where the results are directly used by physicians or other clinical professionals to adjust treatment or therapy) or in self-management, where the results are used directly by patients to support their self-management of asthma. By consensus, the Committee agreed that an appropriate alternative focus for self-management symptom monitoring is a personalised asthma action plan.</p><p>Although the evidence reviewed did not support a role for symptom diaries/questionnaires in routine monitoring, the Committee did not want to infer that such diaries or questionnaires had no use at all. The questionnaires have been formally validated, and the committee agreed that asking the focussed questions within them is a much better way of assessing asthma control than a general “how have you been?” approach. Furthermore, the committee were aware of evidence that asthma control questionnaires are predictive of future risk of severe asthma attacks. They noted that the study protocols employed the questionnaires over short periods of time (they were filled in at weekly intervals in one study) and while they concluded that the evidence showed this was not a worthwhile exercise, they agreed by consensus that filling in a questionnaire at a person’s regular review (which will be an annual review in most people with asthma) should provide useful information. It was also suggested that it would be useful to fill in a questionnaire when any treatment change was being contemplated, to provide an objective baseline against which any improvement could be measured. However, the committee recognised that this was a separate issue from that of regular monitoring and did not make a recommendation on this point.</p><p>In keeping with the above, the Lay Committee members noted that validated questionnaires such as ACT and ACQ are chronic management tools that require the patient to recall symptoms over several weeks, rather than an acute management tool (to assess symptoms on a day-to-day basis). The recall element of the questionnaires can be difficult to complete. This view further supports the Committee’s agreement that daily or weekly monitoring of asthma should not rely on symptom questionnaires.</p><p>No significant harms were reported, and the committee therefore did not recommend against using the questionnaires over short periods of time if the person with asthma and the relevant healthcare professional agreed that this served a useful purpose.</p></div><div id="niceng245er12.s1.2.6"><h4>1.2.6. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendation 1.5.2.</p></div></div><div id="niceng245er12.s1.rl.r1"><h3>1.3. References</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref1">Mehuys
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E, Van Bortel
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L, De Bolle
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L, et al (2008) Effectiveness of pharmacist intervention for asthma control improvement
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<em>European Respiratory Journal</em>
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31 (4): 790–799.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/18094011" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18094011</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref2">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. . London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref3">Pool
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AC, Kraschnewski
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JL, Poger
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JM, et al (2017) Impact of online patient reminders to improve asthma care: A randomized controlled trial
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<em>PloS One</em>
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12 (2): e0170447.
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[<a href="/pmc/articles/PMC5291361/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5291361</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28158200" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28158200</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref4">Rikkers-Mutsaerts
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ER, Winters
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AE, Bakker
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MJ, et al (2012) Internet-based self-management compared with usual care in adolescents with asthma: a randomized controlled trial
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<em>Pediatric Pulmonology</em>
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47 (12): 1170–1179.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/22644646" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22644646</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref5">van den Wijngaart
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LS, Roukema
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J, Boehmer
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ALM, et al (2017) A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control
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<em>The european respiratory journal</em>
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50 (4). [<a href="https://pubmed.ncbi.nlm.nih.gov/28982775" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28982775</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref6">van der Meer
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V, Bakker
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MJ, van den Hout
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WB, et al (2009) Internet-based self-management plus education compared with usual care in asthma: a randomized trial
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<em>Annals of Internal Medicine</em>
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151 (2): 110–120.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19620163" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19620163</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref7">van Gaalen
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JL, Beerthuizen
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T, van der Meer
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V, et al (2013) Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial
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<em>Journal of Medical Internet Research</em>
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15 (9): e188.
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[<a href="/pmc/articles/PMC3785973/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3785973</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24028826" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24028826</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref8">Ye
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L, Gao
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X, Tu
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C, et al (2021) Comparative analysis of effectiveness of asthma control test-guided treatment versus usual care in patients with asthma from China
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<em>Respiratory Medicine</em>
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182: 106382.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/33892217" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33892217</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er12.ref9">Zhang
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J, Yin
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C, Li
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H, et al (2020) Application of Once-Monthly Self-Reported ACT Questionnaire in Management of Adherence to Inhalers in Outpatients with Asthma
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<em>Patient preference and adherence</em>
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14: 1027–1036.
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[<a href="/pmc/articles/PMC7311206/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7311206</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32606619" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32606619</span></a>]</div></p></li></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng245er12.appa"><h3>Appendix A. Review protocols</h3><p id="niceng245er12.appa.et1"><a href="/books/NBK612147/bin/niceng245er12-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for symptom diary for monitoring</a><span class="small"> (PDF, 212K)</span></p><p id="niceng245er12.appa.et2"><a href="/books/NBK612147/bin/niceng245er12-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 165K)</span></p></div><div id="niceng245er12.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng245er12.appb.et1"><a href="/books/NBK612147/bin/niceng245er12-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 181K)</span></p><p id="niceng245er12.appb.et2"><a href="/books/NBK612147/bin/niceng245er12-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health economic literature search strategy</a><span class="small"> (PDF, 178K)</span></p></div><div id="niceng245er12.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng245er12.appc.et1"><a href="/books/NBK612147/bin/niceng245er12-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of Symptom diary</a><span class="small"> (PDF, 102K)</span></p></div><div id="niceng245er12.appd"><h3>Appendix D. Effectiveness evidence</h3><p id="niceng245er12.appd.et1"><a href="/books/NBK612147/bin/niceng245er12-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (629K)</span></p></div><div id="niceng245er12.appe"><h3>Appendix E. Forest plots</h3><p id="niceng245er12.appe.et1"><a href="/books/NBK612147/bin/niceng245er12-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (264K)</span></p></div><div id="niceng245er12.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng245er12.appf.et1"><a href="/books/NBK612147/bin/niceng245er12-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (310K)</span></p></div><div id="niceng245er12.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng245er12.appg.et1"><a href="/books/NBK612147/bin/niceng245er12-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 40. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 198K)</span></p></div><div id="niceng245er12.apph"><h3>Appendix H. Economic evidence tables</h3><p>None.</p></div><div id="niceng245er12.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng245er12.appi.s40"><h4>I.1. Clinical studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er12appitab1"><a href="/books/NBK612147/table/niceng245er12.appi.tab1/?report=objectonly" target="object" title="Table 20" class="img_link icnblk_img" rid-ob="figobniceng245er12appitab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er12.appi.tab1"><a href="/books/NBK612147/table/niceng245er12.appi.tab1/?report=objectonly" target="object" rid-ob="figobniceng245er12appitab1">Table 20</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the clinical review. </p></div></div></div><div id="niceng245er12.appi.s2"><h4>I.2. Health Economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><p>None.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>BTS/NICE/SIGN collaborative guideline NG245</p><p>Evidence reviews underpinning recommendation 1.5.2 in the guideline</p><p>Developed by BTS, NICE and SIGN</p></div><div><p><b>Disclaimer</b>: The recommendations in this collaborative guideline represent the view of BTS, NICE and SIGN, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>This collaborative guideline covers health and care in England and Scotland. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a> and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. This collaborative guideline is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK612147</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/39965061" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">39965061</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng245er12tab1"><div id="niceng245er12.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng245er12.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng245er12.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>People with a diagnosis of asthma (physician diagnosis/definitive diagnosis by objective test)</p>
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<p>All ages, stratified into the following 3 different groups:<ul><li class="half_rhythm"><div>Children (<5 years old)</div></li><li class="half_rhythm"><div>Children and young people (5–16 years)</div></li><li class="half_rhythm"><div>Adults (>17 years old)</div></li></ul></p>
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</td></tr><tr><th id="hd_b_niceng245er12.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng245er12.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Monitoring the following, and using the outcomes of scores/questionnaires to adjust management/therapy according to physician decision or personalised treatment plan:<ul><li class="half_rhythm"><div>Symptom score or diaries</div></li><li class="half_rhythm"><div>Symptom/control questionnaires<ul class="circle"><li class="half_rhythm"><div>Asthma Control Test, ACT (including caregivers or paediatric version, CACT)</div></li><li class="half_rhythm"><div>Asthma Control Questionnaire, ACQ (including mini ACQ or paediatric ACQ)</div></li><li class="half_rhythm"><div>RCP 3 questions</div></li></ul></div></li><li class="half_rhythm"><div>Quality of life questionnaires (asthma specific)<ul class="circle"><li class="half_rhythm"><div>Health-related QoL</div></li><li class="half_rhythm"><div>Asthma Quality of Life Questionnaire, AQLQ (including paediatric version, PAQLQ)</div></li></ul></div></li></ul></td></tr><tr><th id="hd_b_niceng245er12.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng245er12.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Comparison of adjustment of asthma therapy based on symptom scores or questionnaires to:<ul><li class="half_rhythm"><div>Usual care: e.g. clinical symptoms (with/without spirometry/PEF) according to guidelines (including BTS/SIGN, GINA)</div></li></ul></p>
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<p>Comparison of adjustment of asthma therapy based on:<ul><li class="half_rhythm"><div>Symptom scores or diaries vs questionnaires</div></li><li class="half_rhythm"><div>Control questionnaire vs other control questionnaire</div></li><li class="half_rhythm"><div>QOL questionnaire vs asthma control questionnaire</div></li></ul></p>
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</td></tr><tr><th id="hd_b_niceng245er12.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng245er12.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All outcomes are considered equally important for decision making and therefore have all been rated as critical:<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Unscheduled healthcare utilisation (ED/A&E visit; hospital admissions; GP out of hours or walk-in centre)</div></li><li class="half_rhythm"><div>Severe asthma exacerbations (defined as asthma exacerbations requiring oral corticosteroid use-dichotomous outcome at ≥6 months, latest time point if more than one)</div></li><li class="half_rhythm"><div>Asthma control assessed by a validated questionnaires (ACQ, ACT; CACT; PACQ; RCP-3; continuous outcome at ≥3 months)</div></li><li class="half_rhythm"><div>Quality of life (QoL) (validated scale, including asthma specific questionnaires AQLQ; health related, pAQLQ; St George’s respiratory questionnaire; continuous outcome at ≥3 months)</div></li><li class="half_rhythm"><div>Lung function (FEV1, PEF)</div></li><li class="half_rhythm"><div>Symptoms (annual symptom free days)</div></li><li class="half_rhythm"><div>Dose of regular asthma therapy / preventer medication (ICS dose)</div></li><li class="half_rhythm"><div>Reliever/ Rescue medication use (SABA use – continuous outcome at ≥3 months)</div></li><li class="half_rhythm"><div>Time off school or work</div></li></ul></td></tr><tr><th id="hd_b_niceng245er12.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng245er12.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>RCTs</div></li></ul>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab2"><div id="niceng245er12.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mehuys 2008 (<a class="bibr" href="#niceng245er12.ref1" rid="niceng245er12.ref1">Mehuys et al., 2008</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Symptom/control questionnaires (ACT monitoring with pharmacist advice based on ACT score, plus education)</p>
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<p>Personal education session (1) from pharmacist on topics including correct use of inhaler, symptom triggers, understanding asthma</p>
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<p>Sessions (2) and (3) at 1 mo and 3 mo for pharmacist advice based on ACT score:</p>
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<p>i. ACT <15: immediate referral to GP or specialist</p>
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<p>ii. ACT 15–19: review inhaler technique and check controller adherence</p>
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<p>iii. ACT >19: no advice, inform patient asthma is well-controlled</p>
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<p>vs</p>
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<p>Usual pharmacist care</p>
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</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults aged 18–50 years with a prescription for asthma medication and treated for asthma >12 months, using controller medication</p>
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<p>N=201</p>
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<p>Mean age (range): 35.5 (18–51) years</p>
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<p>Belgium</p>
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</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Unscheduled healthcare utilisation (emergency department visits or hospitalisations)</p>
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<p>Asthma exacerbations (requiring treatment with oral glucocorticoids or an emergency department visit or hospital admission due to asthma)</p>
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<p>Asthma control (ACT)</p>
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<p>Quality of life [Asthma quality of life questionnaire (AQLQ)]</p>
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<p>Lung function (Morning PEF)</p>
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<p>Reliever/rescue mediation use</p>
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<p>At 6 months</p>
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</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: adults</p>
|
|
<p>Intervention indirectness: intervention group received education, but not the usual care group.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pool 2017 (<a class="bibr" href="#niceng245er12.ref3" rid="niceng245er12.ref3">Pool et al., 2017</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom scores or diaries (Symptom questions with feedback to support self-management)</p>
|
|
<p>Intervention participants were asked to use an online tool at least once each month (and within 14 days of their next scheduled health care provider visit), in which they would answer 11 questions about their asthma symptoms (e.g., rescue inhaler frequency, night symptom frequency), availability of oral corticosteroids at home for exacerbations, and asthma care received from providers, such as an asthma management plan. Participants were also asked to enter their current asthma medications, the number of days each week that each medication was used and identify if any medicines bothered them; and record their next scheduled visit with their asthma care provider.</p>
|
|
<p>Based on their answers and pre-written rules, the online tool provided tailored feedback reminding patients to ask providers specific questions about their asthma medications and perform specific asthma self-care, to improve adherence to the 2007 NAEPP treatment guidelines. Feedback included lay-person explanations and links to an external website that supported the recommendation.</p>
|
|
<p>Vs</p>
|
|
<p>Control condition received questions and were given feedback about preventive services (e.g., colon cancer screening) that would be unlikely to change asthma care.</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults aged 21–60 years. with persistent asthma based on their pattern of medication use specific to asthma, emergency room visits or hospitalizations with a principal diagnosis of asthma, and outpatient visits coded by the provider with a diagnosis of asthma.</p>
|
|
<p>N=408</p>
|
|
<p>Mean age (SD): 47.4 (9.3) years</p>
|
|
<p>United States (members of a health insurance company)</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Unscheduled healthcare utilisation (number of emergency room visits; number of outpatient visits)</p>
|
|
<p>Asthma control (ACT)</p>
|
|
<p>Dose of regular asthma therapy/preventer medication (number of asthma medications; number of asthma controller medications)</p>
|
|
<p>At 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: adults</p>
|
|
<p>Intervention indirectness: an unvalidated symptom questionnaire. 4 of 11 questions relate to asthma care rather than symptoms.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rikkers 2012 (<a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers-Mutsaerts et al., 2012</a>, <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer et al., 2009</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom/control questionnaires (ACQ monitoring with feedback to support self-management, plus education)</p>
|
|
<p>Internet-based self-management: consisting of all four components of self-management support programs: education, self-monitoring, an electronic action plan, and regular medical review.</p>
|
|
<p>Education was provided as web-based portal including interactive communication with a specialized nurse, and 2 face-to-face group based education sessions focussing on self-management.</p>
|
|
<p>Patients monitored their asthma weekly by completing an electronic version of the ACQ and receiving feedback and 4 types of self-treatment advice on how to adjust their treatment according to a predefined treatment plan:</p>
|
|
<p>i. 4 consecutive ACQ scores of 0.5 or less= decrease treatment according to treatment plan.</p>
|
|
<p>ii. 2 consecutive scores > 0.5 but < 1.0= increase treatment according to treatment plan.</p>
|
|
<p>iii. 1 score ≥1.0 but < 1.5 = immediately increase treatment according to treatment plan.</p>
|
|
<p>iv. 1 score ≥ 1.5= immediately increase treatment and contact the asthma nurse.</p>
|
|
<p>Vs</p>
|
|
<p>Usual care: care by their physician according to the Dutch guidelines on asthma management in children in general practice and in hospitals. Commonly, they visited their general practitioner or paediatrician every 3 months or twice per year once control of asthma had been achieved.</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adolescents aged 12–17 years, with a doctor’s diagnosis of mild to severe persistent asthma characterised by a prescription of ICS more than 3 months in the previous years.</p>
|
|
<p>N=90</p>
|
|
<p>Mean age (range): 13.5 (12–17) years</p>
|
|
<p>The Netherlands</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Asthma exacerbations (deterioration in asthma that required oral steroids for 3 days or more, as reported in 3-monthly questionnaires)</p>
|
|
<p>Asthma control (ACQ)</p>
|
|
<p>Quality of life (Paediatric Asthma QOL questionnaire)</p>
|
|
<p>Symptoms (symptom-free days)</p>
|
|
<p>Dose of regular asthma therapy / preventer medication (daily ICS dose)</p>
|
|
<p>At 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: children and young people</p>
|
|
<p>SMASHING trial</p>
|
|
<p>Intervention indirectness: intervention group received additional web-based and face-to-face education sessions.</p>
|
|
<p>Population indirectness: unknown proportion of 17 year olds.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van der Meer 2009(<a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">van der Meer et al., 2009</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom/control questionnaires (ACQ monitoring with feedback to support self-management, plus education)</p>
|
|
<p>Internet-based self-management: including weekly asthma control monitoring and treatment advice, online and group education and remote Web communications.</p>
|
|
<p>Education was provided as web-based portalincluding interactive communication with a specialized nurse, and 2 face-to-face group based education sessions focussing on self-management.</p>
|
|
<p>Patients monitored their asthma weekly by completing an electronic version of the ACQ and receiving feedback and 4 types of self-treatment advice on how to adjust their treatment according to a predefined treatment plan:</p>
|
|
<p>i.4 consecutive ACQ scores of 0.5 or less= decrease treatment according to treatment plan.</p>
|
|
<p>ii. 2 consecutive scores > 0.5 but < 1.0= increase treatment according to treatment plan.</p>
|
|
<p>iii. 1 score ≥1.0 but < 1.5 = immediately increase treatment according to treatment plan.</p>
|
|
<p>iv. 1 score ≥ 1.5= immediately increase treatment and contact the asthma nurse.</p>
|
|
<p>Vs</p>
|
|
<p>Usual care: asthma care according to the Dutch general practice guidelines on asthma management in adults, which recommend a medical review and treatment adjustment every 2 to 4 weeks in unstable asthma and medical review once or twice yearly for patients whose asthma is under control.</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with asthma treated with ICS for 3 months or more during the previous year and who had access to the internet.</p>
|
|
<p>N=200</p>
|
|
<p>Mean age (range): 36.6 (18–50) years</p>
|
|
<p>The Netherlands</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Asthma exacerbations [deterioration requiring emergency treatment or hospitalization or the need for oral steroids for 3 days or more (as judged by the attending physician)]</p>
|
|
<p>Asthma control (ACQ)</p>
|
|
<p>Quality of life (Asthma-related QOL)</p>
|
|
<p>Lung function (FEV1)</p>
|
|
<p>Symptoms (symptom free days)</p>
|
|
<p>Dose of regular asthma therapy / preventer medication (daily ICS use)</p>
|
|
<p>At 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: Adults</p>
|
|
<p>Multicentre RCT (SMASHING trial)</p>
|
|
<p>Same intervention as <a class="bibr" href="#niceng245er12.ref4" rid="niceng245er12.ref4">Rikkers-Mutsaerts 2012</a></p>
|
|
<p>Intervention indirectness: intervention group received additional web-based and face-to-face education sessions.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van Gaalen 2013(<a class="bibr" href="#niceng245er12.ref7" rid="niceng245er12.ref7">van Gaalen et al., 2013</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">as <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">Van der Meer 2009</a></td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N=107</p>
|
|
<p>Otherwise, as <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">Van der Meer 2009</a></p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Asthma control (ACQ)</p>
|
|
<p>Quality of life (AQLQ)</p>
|
|
<p>At 30 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: adults</p>
|
|
<p>Longer-term follow-up of <a class="bibr" href="#niceng245er12.ref6" rid="niceng245er12.ref6">Van der Meer (2009)</a> (intervention ceased at 12 months)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Van den Wijngaart 2017 (<a class="bibr" href="#niceng245er12.ref5" rid="niceng245er12.ref5">van den Wijngaart et al., 2017</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom/control questionnaires (C-ACT monitoring with feedback to support self-management, plus education)</p>
|
|
<p>Virtual asthma clinic: a web-based portal with a chat and forum module for peers, an information module to enhance knowledge about asthma, and a secure and private module in which the child/parent can log in to consult an individual treatment plan and communicate with the asthma management team.</p>
|
|
<p>Outpatient visits every 8 months.</p>
|
|
<p>Digital (c-)ACT completed monthly: If the (C-)ACT score was ⩾20, automatic default messages were emailed with positive and encouraging content. If the (C-)ACT score was <20 feedback to the participants included advice to check their medication use, an individual action plan and a request to contact their asthma team when symptoms persisted. Feedback also sent to the asthma team to prompt contacting the participant within 2 working days to address clinical status.</p>
|
|
<p>Vs</p>
|
|
<p>Usual care: routine outpatient visits every 4 months, during which patients completed a digital version of the (C-)ACT to assess asthma control. Results of/feedback from (C-)ACT not available to physician or patient.</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Children aged 6–16 years, with a doctor’s diagnosis of asthma based on symptoms and a bronchodilator response of forced expiratory volume in 1 s (FEV1) % pred >9%, and/or airway hyperresponsiveness, and/or signs of eosinophilic airways inflammation. All had to have at least one allergy for airborne allergens confirmed by positive skin prick tests and/or blood tests</p>
|
|
<p>N=210</p>
|
|
<p>Mean (SD) age: 11.3 (2.8) years</p>
|
|
<p>The Netherlands</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Unscheduled healthcare utilisation (unscheduled outpatient visits; visits to emergency departments; hospital admissions)</p>
|
|
<p>Asthma exacerbations (exacerbations treated with systemic corticosteroids)</p>
|
|
<p>Asthma control (C-ACT and ACT)</p>
|
|
<p>Lung function (FEV1 % predicted)</p>
|
|
<p>Symptoms (symptom-free days)</p>
|
|
<p>At 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: children and young people</p>
|
|
<p>Intervention indirectness: intervention group received interactive web-based education.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ye 2021(<a class="bibr" href="#niceng245er12.ref8" rid="niceng245er12.ref8">Ye et al., 2021</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom/control questionnaires (ACT-guided treatment)</p>
|
|
<p>ACT guided treatment comprising of:</p>
|
|
<p>i. ACT score=25, ≥3 months; step down treatment</p>
|
|
<p>ii. ACT score= ≥20, <25 or ACT score=25, <3 months; no change</p>
|
|
<p>iii. ACT score ≤19; treatment adjustment: step-up</p>
|
|
<p>Vs</p>
|
|
<p>Usual care: treatment based on physicians’ subjective judgment asking questions including: ‘what is the major symptom you have’, ‘what kind of medicines did you take’</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People aged 18–70 years with an ACT score <20, documented clinical history of asthma for ≥6 months, and using ICS alone or ICS/LABA treatment within 1 year prior to or at Visit 0</p>
|
|
<p>N=530</p>
|
|
<p>Mean age (SD): 48 (13) years</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Asthma exacerbations (moderate/severe asthma exacerbations, not defined)</p>
|
|
<p>Asthma control (ACT)</p>
|
|
<p>Lung function (FEV1)</p>
|
|
<p>Quality of life (AQLQ)</p>
|
|
<p>At 24 weeks</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: Adults</p>
|
|
<p>Cluster-RCT; multicentre study.</p>
|
|
<p>Patients in both groups were required to record PEF, symptoms and medication in a paper diary record card every day. These were checked to evaluate therapeutic compliance.</p>
|
|
<p>Use of ICS/bronchodilators was modified according to GINA recommendations.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zhang 2020 (<a class="bibr" href="#niceng245er12.ref9" rid="niceng245er12.ref9">Zhang et al., 2020</a>)</td><td headers="hd_h_niceng245er12.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Symptom/control questionnaires (ACT monitoring with results sent to physician)</p>
|
|
<p>Observational group: in addition to the control group treatment, participants undertook a self-reported ACT questionnaire at the end of each month and were asked to bring the results to physicians/pharmacists at the next visit/submit them via email/webchat; they were guided by physicians/pharmacists on the significance of the ACT and given knowledge related to disease, symptom control and inhalation therapy.</p>
|
|
<p>Vs</p>
|
|
<p>Control group: patients were treated with standardised medication of combination of ICS/LABA for asthma control and health education involving inhaler technique training.</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with asthma diagnosed according to the diagnostic criteria for bronchial asthma prevention and treatment guidelines developed by the Asthma workgroup of the Chinese Medical Association Respiratory Diseases Branch.</p>
|
|
<p>N=627</p>
|
|
<p>Mean age (SD): 42.7 (11.8) years</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Lung function (FEV1 and PEF)</p>
|
|
<p>At 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Strata: Adults</p>
|
|
<p>Intervention indirectness: unclear what adjustments to treatment and/or self-management made in response to ACT monitoring, though results were sent to physician</p>
|
|
<p>Both arms received training in pulmonary function measurement and inhaler techniques</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab3"><div id="niceng245er12.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: Symptom/control questionnaires (ACT monitoring with pharmacist advice based on ACT score, plus education) vs usual care (by pharmacists) in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab3_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab3_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab3_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab3_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab3_1_1_1_5" id="hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care (by pharmacists) in adults</th><th headers="hd_h_niceng245er12.tab3_1_1_1_5" id="hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with ACT-score & pharmacist advice</th><th headers="hd_h_niceng245er12.tab3_1_1_1_6" id="hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma exacerbations (severe exacerbations, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>150 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 1.09</b> (0.46 to 2.62)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">114 per 1,000</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p><b>10 more per 1,000</b> (62 fewer to 185 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Unscheduled healthcare utilisation (emergency department visits or hospitalisation, final scores, lower is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>150 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>c</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 0.17</b> (0.02 to 1.46)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">71 per 1,000</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p><b>59 fewer per 1,000</b> (70 fewer to 33 more)</p>
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|
<p>Clinically important difference favouring symptom/control questionnaires</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MID (imprecision) = 0.8 – 1.25</p>
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<p>MID (clinical importance) = 30 per 1000</p>
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|
</td></tr><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACT score, range 0 to 25, final score, higher is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>150 (1 RCT)</p>
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<p>Follow-up: 6 months</p>
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</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (ACT score, range 0 to 25, final score, higher is better, FUP 6 mo) was <b>19.7</b></td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MD <b>0.5 higher</b> (0.86 lower to 1.86 higher)</p>
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<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 3 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Quality of life (asthma-QoL questionnaire, scale 0 to 7, final score, higher is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>150 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean quality of life (asthma-QoL questionnaire, scale 0 to 7, final score, higher is better, FUP 6 Mo) was <b>5.8</b></td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.2 higher</b> (0.06 lower to 0.46 higher)</p>
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<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (morning PEF, % predicted, final score, higher is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>150 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>g</sup><sup>,</sup><sup>h</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (morning PEF, % predicted, final score, higher is better, FUP 6 Mo); at 6 months) was <b>79.1</b></td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>4.9 higher</b> (1.25 lower to 11.05 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=9.05 (calculated as baseline SD/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Reliever/rescue medication use (puff/day; mean over previous 14 days, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>150 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean reliever/rescue medication use (puff/day; mean over previous 14 days, final score, lower is better, FUP 6 Mo) was <b>0.9</b></td><td headers="hd_h_niceng245er12.tab3_1_1_1_5 hd_h_niceng245er12.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.23 lower</b> (0.66 lower to 0.2 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab3_1_1_1_6 hd_h_niceng245er12.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.81 (established MID)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab3_1"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias (no info about prespecified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab3_2"><p class="no_margin">Downgraded by one increment for intervention indirectness (intervention group received education as well and questionnaire monitoring)</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab3_3"><p class="no_margin">Downgraded by two increments for imprecision because the confidence interval crosses both MIDs (0.8–1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab3_4"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias (no info about prespecified analyses and no information about outcome assessment)</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng245er12.tab3_5"><p class="no_margin">Downgraded by two increments because study at high risk of bias (self-reported outcome and unblinded: no information in prespecified analyses and unclear why ITT analysis presented for primary outcomes and per-protocol analysis for secondary outcomes)</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng245er12.tab3_6"><p class="no_margin">Published MIDs: ACT=3; AQLQ=0.5; reliever/rescue medication=0.81 puffs/day</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng245er12.tab3_7"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias (no information about prespecified analyses and unclear why PP used for secondary outcomes but ITT for primary outcomes)</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng245er12.tab3_8"><p class="no_margin">Downgraded by one increment for imprecision because the confidence interval crosses one MID (calculated as baseline SD of control and intervention groups /2=9.05)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab4"><div id="niceng245er12.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Symptom/control questionnaires (ACT-guided treatment) vs usual care (physician’s judgment) in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab4_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab4_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab4_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab4_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab4_1_1_1_5" id="hd_h_niceng245er12.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care (physician’s judgment) in adults</th><th headers="hd_h_niceng245er12.tab4_1_1_1_5" id="hd_h_niceng245er12.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with ACT-guided treatment</th><th headers="hd_h_niceng245er12.tab4_1_1_1_6" id="hd_h_niceng245er12.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma exacerbations (moderate/severe exacerbations, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>507 (1 RCT)</p>
|
|
<p>Follow-up: 24 weeks</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 0.88</b> (0.35 to 2.18)</td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">38 per 1,000</td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p><b>5 fewer per 1,000</b> (25 fewer to 45 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_6 hd_h_niceng245er12.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (LS mean change in ACT score, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>504 (1 RCT)</p>
|
|
<p>Follow-up: 24 weeks</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁◯◯ Low<sup>d</sup><sup>,</sup><sup>e</sup></td><td headers="hd_h_niceng245er12.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (LS mean change in ACT score, change score, higher is better, FUP 24 weeks) was <b>5.6</b></td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>1.3 higher</b> (0.5 higher to 2.1 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_6 hd_h_niceng245er12.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 3 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (FEV1 (% change score; higher is better)</td><td headers="hd_h_niceng245er12.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>504 (1 RCT)</p>
|
|
<p>Follow-up: 24 weeks</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁⨁◯ Moderate<sup>f</sup><sup>,</sup><sup>g</sup></td><td headers="hd_h_niceng245er12.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (FEV1 (% change score; higher is better, FUP 24 weeks) was <b>3.83</b></td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>1.85 higher</b> (1.58 lower to 5.28 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_6 hd_h_niceng245er12.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=9.8 (calculated as follow-up SD/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Quality of life (AQLQ symptom domain, range 1–7; change score; higher is better)</td><td headers="hd_h_niceng245er12.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>504 (1 RCT)</p>
|
|
<p>Follow-up: 24 weeks</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>d</sup><sup>,</sup><sup>h</sup></td><td headers="hd_h_niceng245er12.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean quality of life (AQLQ symptom domain, range 1–7; change score; higher is better, FUP 24 weeks) was <b>1.2</b></td><td headers="hd_h_niceng245er12.tab4_1_1_1_5 hd_h_niceng245er12.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.3 higher</b> (0 to 0.6 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab4_1_1_1_6 hd_h_niceng245er12.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab4_1"><p class="no_margin">Downgraded by two increments due to concerns about risk of bias (exacerbations determined by patients record card and unblinded; no information about pre-specified analyses in protocol.)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab4_2"><p class="no_margin">Downgraded by one increment for outcome indirectness (not defined and so not clear whether meets protocol definition)</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab4_3"><p class="no_margin">Downgraded by two increments for imprecision because the confidence interval crossed both MIDs (MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab4_4"><p class="no_margin">Downgraded by two increments due to concerns about risk of bias (subjective outcome and assessors aware of intervention; no information about prespecified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng245er12.tab4_5"><p class="no_margin">Published MID for ACT=3</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng245er12.tab4_6"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias (no information about prespecified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng245er12.tab4_7"><p class="no_margin">MID= Follow-up SD/2=9.8 (baseline SDs not available)</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng245er12.tab4_8"><p class="no_margin">Downgraded by one increment for imprecision because confidence interval crosses one MID (published MID for AQLQ=0.5)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab5"><div id="niceng245er12.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: Symptom control/questionnaires (ACT monitoring with results sent to physician)) vs usual care (ICS/LABA & education) in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab5_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab5_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab5_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab5_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab5_1_1_1_5" id="hd_h_niceng245er12.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care (ICS/LABA & education) in adults</th><th headers="hd_h_niceng245er12.tab5_1_1_1_5" id="hd_h_niceng245er12.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with ACT self-management</th><th headers="hd_h_niceng245er12.tab5_1_1_1_6" id="hd_h_niceng245er12.tab5_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (FEV1 % predicted, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>627 (1 RCT)</p>
|
|
<p>Follow-up: 6 months</p>
|
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</td><td headers="hd_h_niceng245er12.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab5_1_1_1_5 hd_h_niceng245er12.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (FEV1 % predicted, change score, higher is better, 6 mo FUP) was <b>19.94</b></td><td headers="hd_h_niceng245er12.tab5_1_1_1_5 hd_h_niceng245er12.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MD <b>16.78 higher</b> (15.85 higher to 17.71 higher)</p>
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<p>Clinically important benefit favouring intervention</p>
|
|
</td><td headers="hd_h_niceng245er12.tab5_1_1_1_6 hd_h_niceng245er12.tab5_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=6.63 (calculated as baseline SD/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (PEF % predicted, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>627 (1 RCT)</p>
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<p>Follow-up: 6 months</p>
|
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</td><td headers="hd_h_niceng245er12.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab5_1_1_1_5 hd_h_niceng245er12.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (PEF % predicted, change score, higher is better, 6 Mo FUP) was <b>23.65</b></td><td headers="hd_h_niceng245er12.tab5_1_1_1_5 hd_h_niceng245er12.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MD <b>17.84 higher</b> (17.14 higher to 18.54 higher)</p>
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<p>Clinically important benefit favouring intervention</p>
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</td><td headers="hd_h_niceng245er12.tab5_1_1_1_6 hd_h_niceng245er12.tab5_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=3.52 (calculated as baseline SD/2)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab5_1"><p class="no_margin">Downgraded by two increments because the study is at high risk of bias (no details about randomisation and pre-specified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab5_2"><p class="no_margin">Downgraded by one increment for intervention indirectness (unclear what adjustments to treatment and/or self-management made in response to ACT monitoring, though results were sent to physician)</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab5_3"><p class="no_margin">MID calculated using baseline SD (of intervention + control groups/2)/2; FEV1: 6.63; PEF: 3.52</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab6"><div id="niceng245er12.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: Symptom control/questionnaires (ACQ monitoring with feedback to support self-management, plus education) vs usual care (Dutch guidelines) in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab6_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab6_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab6_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab6_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab6_1_1_1_5" id="hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care (Dutch guidelines) in adults</th><th headers="hd_h_niceng245er12.tab6_1_1_1_5" id="hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with ACQ-feedback + self-management</th><th headers="hd_h_niceng245er12.tab6_1_1_1_6" id="hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma exacerbations, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>200 (1 RCT)</p>
|
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<p>Follow-up: 12 months</p>
|
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</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>HR 1.18</b> (0.51 to 2.73)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">101 per 1,000</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p><b>17 more per 1,000</b> (48 fewer to 151 more)</p>
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<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MID (imprecision) = 0.8 – 1.25</p>
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<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACQ, range 0 to 7, lower is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>200 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>d</sup><sup>,</sup><sup>e</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (ACQ, range 0 to 7, lower is better, FUP 12 Mo) was <b>−0.06</b></td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
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<p>MD <b>0.47 lower</b> (0.64 lower to 0.3 lower)</p>
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<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACQ, range 0 to 7, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>107 (1 RCT)</p>
|
|
<p>Follow-up: 30 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Not reported</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>MD <b>0.33 lower</b> (0.61 lower to 0.05 lower)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Quality of life (AQLQ, range 1 to 7, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>200 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>d</sup><sup>,</sup><sup>e</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean quality of life (AQLQ, range 1 to 7, change score, higher is better, FUP 12 Mo) was <b>0.18</b></td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.38 higher</b> (0.2 higher to 0.56 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Quality of life (AQLQ, range 1 to 7, final score, higher is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>107 (1 RCT)</p>
|
|
<p>Follow-up: 30 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Not reported</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.29 higher</b> (0.01 higher to 0.57 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (FEV1, L, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>200 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (FEV1, L, change score, higher is better, FUP 12 Mo) was <b>−0.01</b></td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.25 higher</b> (0.03 higher to 0.47 higher)</p>
|
|
<p>Clinically important benefit favouring intervention</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.23 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Symptoms (symptom-free days, %, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>200 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>d</sup><sup>,</sup><sup>g</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean symptoms (symptom-free days, %, change score, higher is better, FUP 12 Mo) was <b>7.3</b></td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>10.9 higher</b> (0.05 higher to 21.75 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=19.55 (SD calculated from 95%CI/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Dose of regular asthma therapy / preventer medication (daily ICS use, mcg, change score)</td><td headers="hd_h_niceng245er12.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>200 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁◯◯ Low<sup>b</sup><sup>,</sup><sup>h</sup><sup>,</sup><sup>i</sup></td><td headers="hd_h_niceng245er12.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean dose of regular asthma therapy / preventer medication (daily ICS use, mcg, change score, FUP 12 Mo) was <b>−48</b></td><td headers="hd_h_niceng245er12.tab6_1_1_1_5 hd_h_niceng245er12.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>57 higher</b> (38 lower to 152 higher)</p>
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|
<p>No clinically important difference</p>
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|
</td><td headers="hd_h_niceng245er12.tab6_1_1_1_6 hd_h_niceng245er12.tab6_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=171.35 (SD calculated from 95%CI/2)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab6_1"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias (no information about prespecified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab6_2"><p class="no_margin">Downgraded by one increment for intervention indirectness (intervention group received additional web-based and face-to-face education sessions)</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab6_3"><p class="no_margin">Downgraded by two increments for imprecision because the confidence interval crosses both MIDs (0.8 to 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab6_4"><p class="no_margin">Downgraded by two increments because study at high risk of bias (self-reported outcome and unblinded study (ACQ measurement part of intervention); no information about pre-specified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng245er12.tab6_5"><p class="no_margin">Downgraded by one increment for imprecision because the confidence interval crosses one MID (published MIDs: ACQ=0.5; AQLQ=0.5; FEV1=0.23L))</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng245er12.tab6_6"><p class="no_margin">Downgraded by two increments because study at high risk of bias (self-reported subjective outcome and unblinded; post-hoc analysis; investigators likely to know 12 month results before reporting 30 month results; unclear information on missing data as longer follow-up participants were re-recruited)</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng245er12.tab6_7"><p class="no_margin">Downgraded by one increment for imprecision because the confidence interval crosses one MID (SD calculated from 95%CI/2=19.55)</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng245er12.tab6_8"><p class="no_margin">Downgraded by one increment due to some concerns about risk of bias [self-reported outcome and unblinded (but not completely subjective an outcome); no information on prespecified outcomes]</p></div></dd></dl><dl class="bkr_refwrap"><dt>i</dt><dd><div id="niceng245er12.tab6_9"><p class="no_margin">MID: SD from 95%CI/2=171.35</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab7"><div id="niceng245er12.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: Symptom scores or diaries (symptom questions with feedback to support self-management) vs control questions and feedback in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab7_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab7_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab7_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab7_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab7_1_1_1_5" id="hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with Control-Qs +feedback</th><th headers="hd_h_niceng245er12.tab7_1_1_1_5" id="hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with Symptom-Qs + feedback +self-management</th><th headers="hd_h_niceng245er12.tab7_1_1_1_6" id="hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Unscheduled healthcare utilisation (number of emergency room visits, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>326 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁⨁◯ Moderate<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean unscheduled healthcare utlisation (number of emergency room visits, change score, lower is better, FUP 12 Mo) was <b>−0.08</b></td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.18 lower</b> (0.43 lower to 0.07 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_6 hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID=0.98</p>
|
|
<p>(calculated as baseline SD/2)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Unscheduled healthcare utilisation (number of outpatient visits, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>326 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁⨁◯ Moderate<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean unscheduled healthcare utilisation (number of outpatient visits, change score, lower is better, FUP 12 Mo) was <b>0</b></td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.13 lower</b> (0.7 lower to 0.45 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_6 hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID=1.99</p>
|
|
<p>(calculated as baseline SD/2)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACT, range 5 to 25, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>325 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁⨁◯ Moderate<sup>a</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (ACT, range 5 to 25, change score, higher is better, FUP 12 Mo) was <b>1.2</b></td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>1.05 higher</b> (0.17 higher to 1.93 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_6 hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 3 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Dose of regular asthma therapy / preventer medication (number of asthma medications, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>326 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁◯◯ Low<sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean dose of regular asthma therapy / preventer medication (number of asthma medications, change score, lower is better, FUP 12 Mo) was <b>0.25</b></td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.17 higher</b> (0.05 lower to 0.39 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_6 hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID=1.0</p>
|
|
<p>(calculated as baseline SD/2)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Dose of regular asthma therapy / preventer medication (number of asthma controller medications, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>326 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁⨁◯◯ Low<sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean dose of regular asthma therapy / preventer medication (number of asthma controller medications, change score, lower is better, FUP 12 Mo) was <b>0.12</b></td><td headers="hd_h_niceng245er12.tab7_1_1_1_5 hd_h_niceng245er12.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>MD <b>0.06 higher</b> (0.09 lower to 0.21 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab7_1_1_1_6 hd_h_niceng245er12.tab7_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=0.78 (calculated as baseline SD/2)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab7_1"><p class="no_margin">Downgraded by 1 increment due to indirectness of intervention (use of non-validated asthma symptom questionnaire. Only 7/11 Q are directly about asthma symptoms)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab7_2"><p class="no_margin">MIDs= SD/2 of the intervention and control group; SDs were calculated using the baseline mean (95% CI) of the intervention and control group to get the standard error and then convert it to SD; MIDs: ED visits: 0.98; outpatient visits: 1.99; asthma medications: 1.0; asthma controller medications: 0.78</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab7_3"><p class="no_margin">Published MID for ACT=3</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab7_4"><p class="no_margin">Downgraded by 2 increments due to indirectness of intervention (use of non-validated asthma symptom questionnaire. Only 7/11 Q are directly about asthma symptoms) and outcome [not identical to dose of regular asthma therapy / preventer medication (ICS dose)]</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab8"><div id="niceng245er12.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Clinical evidence summary Symptom/control questionnaires (ACQ monitoring with feedback to support self-management, plus education) compared to usual care (Dutch guidelines) in children and young people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab8_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab8_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab8_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab8_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab8_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab8_1_1_1_5" id="hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care (Dutch guidelines) in CYP</th><th headers="hd_h_niceng245er12.tab8_1_1_1_5" id="hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with ACQ-feedback + self-management</th><th headers="hd_h_niceng245er12.tab8_1_1_1_6" id="hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma exacerbations (lower is better)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>90 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 0.96</b> (0.33 to 2.74)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">136 per 1,000</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p><b>5 fewer per 1,000</b> (91 fewer to 237 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_6 hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACQ, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>90 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (ACQ, change score, lower is better, FUP 12 Mo) was <b>0.79</b></td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.05 lower</b> (0.35 lower to 0.25 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_6 hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Quality of life (paediatric asthma-QOL-q, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>90 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean quality of life (paediatric asthma-QOL-q, change score, higher is better, FUP 12 Mo) was <b>6.05</b></td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.05 lower</b> (0.5 lower to 0.4 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_6 hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 0.5 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Dose of regular asthma therapy / preventer medication (daily ICS dose, change score, lower is better)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>90 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>e</sup></td><td headers="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean dose of regular asthma therapy / preventer medication (daily ICS dose, change score, lower is better, FUP 12 Mo) was <b>265</b> mcg</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>14 mcg higher</b> (75 lower to 103 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_6 hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=107.7 (calculated using 95%CI of mean difference to calculate SD/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Symptoms (symptom free days, change score, higher is better)</td><td headers="hd_h_niceng245er12.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>90 (1 RCT)</p>
|
|
<p>Follow-up: 12 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean symptoms (symptom free days, change score, higher is better, FUP 12 Mo) was <b>80</b></td><td headers="hd_h_niceng245er12.tab8_1_1_1_5 hd_h_niceng245er12.tab8_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>4 higher</b> (9.7 lower to 17.7 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab8_1_1_1_6 hd_h_niceng245er12.tab8_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID=16.7</p>
|
|
<p>(calculated using 95%CI of mean difference to calculate SD/2)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab8_1"><p class="no_margin">Downgraded by two increments because study at high risk of bias (>10% differential rate of missing data between groups at 12 months; subjective self-reported outcome & lack of blinding; No information on pre-specified analyses)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab8_2"><p class="no_margin">Downgraded by two increments for indirectness for population (mixed age group including people >16 years) and intervention (intervention group received additional web-based and face-to-face education sessions).</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab8_3"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs (MID for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab8_4"><p class="no_margin">Based on MID for ACQ& pediatric QoL in children and young people: 0.5 for both measures</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng245er12.tab8_5"><p class="no_margin">Downgraded by one increment for imprecision because the confidence interval crossed one MID (MID calculated using 95% C1 of mean difference to calculate SD =215.34; MID=SD/2=107.7)</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng245er12.tab8_6"><p class="no_margin">Downgraded by 1 increment as the confidence interval crossed one MID (MID calculated using 95% CI of the mean difference by calculating the standard error and converting to SD; MID:SD/2= 16.7)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12tab9"><div id="niceng245er12.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Clinical evidence summary Symptom/control questionnaires (C-ACT monitoring with feedback to support self-management, plus education) vs usual care in children and young people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab9_1_1_1_1" style="text-align:center;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab9_1_1_1_2" style="text-align:center;vertical-align:middle;">№ of participants (studies) Follow-up</th><th id="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab9_1_1_1_3" style="text-align:center;vertical-align:middle;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng245er12.tab9_1_1_1_4" style="text-align:center;vertical-align:middle;">Relative effect (95% CI)</th><th id="hd_h_niceng245er12.tab9_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Anticipated absolute effects</th><th id="hd_h_niceng245er12.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"></th></tr><tr><th headers="hd_h_niceng245er12.tab9_1_1_1_5" id="hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk with usual care</th><th headers="hd_h_niceng245er12.tab9_1_1_1_5" id="hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk difference with C-ACT-feedback + self-management</th><th headers="hd_h_niceng245er12.tab9_1_1_1_6" id="hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Unscheduled healthcare utilisation (visits to emergency department, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 1.50</b> (0.26 to 8.79)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">19 per 1,000</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p><b>10 more per 1,000</b> (14 fewer to 148 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Hospital admissions (final score, lower is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 0.50</b> (0.05 to 5.43)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">19 per 1,000</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p><b>10 fewer per 1,000</b> (18 fewer to 84 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Unscheduled healthcare utilisation (unscheduled visits to outpatients, final score, lower is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 1.35</b> (0.88 to 2.07)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">248 per 1,000</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p><b>87 more per 1,000</b> (30 fewer to 265 more)</p>
|
|
<p>Clinically important difference favouring usual care</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 100 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma exacerbations (final score, lower is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;"><b>RR 0.89</b> (0.48 to 1.65)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">171 per 1,000</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p><b>19 fewer per 1,000</b> (89 fewer to 111 more)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MID (imprecision) = 0.8 – 1.25</p>
|
|
<p>MID (clinical importance) = 30 per 1000</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (ACT, range 5 to 25, final score; higher is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>f</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (ACT) was <b>16</b></td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.8 higher</b> (0.04 lower to 1.64 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 3 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Asthma control (C-ACT, range 0 to 27, final score; higher is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>e</sup><sup>,</sup><sup>g</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean asthma control (C-ACT) was <b>22.3</b></td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>1.4 higher</b> (0.48 higher to 2.32 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID= 2 (established MID)</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Lung function (FEV1, % predicted, final score, higher is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>b</sup><sup>,</sup><sup>h</sup><sup>,</sup><sup>i</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean lung function (FEV1, % predicted, final score; FUP 16 Mo) was <b>92.3</b></td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>MD <b>0.2 lower</b> (4.02 lower to 3.62 higher)</p>
|
|
<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=7.05 (calculated as baseline SD/2)</td></tr><tr><td headers="hd_h_niceng245er12.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Symptoms (symptom free days, final score; higher is better)</td><td headers="hd_h_niceng245er12.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
|
<p>210 (1 RCT)</p>
|
|
<p>Follow-up: 16 months</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">⨁◯◯◯ Very low<sup>e</sup><sup>,</sup><sup>i</sup><sup>,</sup><sup>j</sup></td><td headers="hd_h_niceng245er12.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">-</td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">The mean symptoms (symptom free days, final score; higher is better, FUP 16 Mo) was <b>27.3</b></td><td headers="hd_h_niceng245er12.tab9_1_1_1_5 hd_h_niceng245er12.tab9_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">
|
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<p>MD <b>1.2 higher</b> (0.44 higher to 1.96 higher)</p>
|
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<p>No clinically important difference</p>
|
|
</td><td headers="hd_h_niceng245er12.tab9_1_1_1_6 hd_h_niceng245er12.tab9_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">MID=2.25 (calculated as baseline SD/2)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng245er12.tab9_1"><p class="no_margin">Downgraded by 2 increments as the evidence was at very high risk of bias (due to lack of information about outcome assessment, adherence, and pre-specified analyses. Intervention-related deviations from protocol also possible due to availability of FEV1 and FENO to treating physicians in both arms)</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng245er12.tab9_2"><p class="no_margin">Downgraded by one increment for intervention indirectness because intervention included web-based education as well as C-ACT monitoring</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng245er12.tab9_3"><p class="no_margin">Downgraded by 2 increments for imprecision because the confidence interval crossed both MIDs (MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng245er12.tab9_4"><p class="no_margin">Downgraded by one increment because the confidence interval crossed one MID (MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl><dl class="bkr_refwrap"><dt>e</dt><dd><div id="niceng245er12.tab9_5"><p class="no_margin">Intervention-related deviations from protocol possible due to availability of FEV1 and FENO to treating physicians; no information about protocol, missing data or adherence; outcome based on self-reports (unblinded)</p></div></dd></dl><dl class="bkr_refwrap"><dt>f</dt><dd><div id="niceng245er12.tab9_6"><p class="no_margin">Published MID for ACT=3</p></div></dd></dl><dl class="bkr_refwrap"><dt>g</dt><dd><div id="niceng245er12.tab9_7"><p class="no_margin">Downgraded by one increment for imprecision because confidence interval crosses one MID (published MID for C-ACT=2)</p></div></dd></dl><dl class="bkr_refwrap"><dt>h</dt><dd><div id="niceng245er12.tab9_8"><p class="no_margin">Unblinded outcome assessors, no information about missing data, protocol or adherence; intervention-related deviations from protocol possible due to availability of FEV1 and FENO to treating physicians</p></div></dd></dl><dl class="bkr_refwrap"><dt>i</dt><dd><div id="niceng245er12.tab9_9"><p class="no_margin">MID for FEV1 % predicted calculated using baseline SD/2= 7.05; for symptom free days: 2.25</p></div></dd></dl><dl class="bkr_refwrap"><dt>j</dt><dd><div id="niceng245er12.tab9_10"><p class="no_margin">. Downgraded by two increments for intervention indirectness (intervention included web-based education as well as C-ACT monitoring) and outcome indirectness (based on C-ACT)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er12appitab1"><div id="niceng245er12.appi.tab1" class="table"><h3><span class="label">Table 20</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612147/table/niceng245er12.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er12.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Ahmed, Sara, Ernst, Pierre, Bartlett, Susan J
|
|
et al (2016) The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial. Journal of medical Internet research
|
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18(12): e313
|
|
[<a href="/pmc/articles/PMC5159614/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5159614</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27908846" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27908846</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Intervention is multi-component digital intervention which includes self-monitoring of symptoms (and eg exercise and medication adherence) plus education (which is linked to nurse management system). Multiple self-monitoring inputs (not just symptom monitoring) determine subsequent management</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Amorha, Kosisochi C; Okonta, Mathew J; Ukwe, Chinwe V (2021) Impact of pharmacist-led educational interventions on asthma control and adherence: single-blind, randomised clinical trial. International journal of clinical pharmacy
|
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43(3): 689–697
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/33136254" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33136254</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component intervention includes instruction on how to complete a symptoms/peak flow diary. But not clear that management was based on this (only one patient completed it for short period)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arga, M., Sahbaz, H., Bakirtas, A.
|
|
et al (2014) Does self-monitoring by means of symptom diaries improve asthma control in children?. Journal of Asthma
|
|
51(3): 299–305 [<a href="https://pubmed.ncbi.nlm.nih.gov/24274828" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24274828</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Observational study. Symptom diary/no symptom diary groups not allocated or randomised.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arikan Ayyildiz, Z., Isik, S., Caglayan-Sozmen, S.
|
|
et al (2014) Effect of asthma education programme on asthma control in children with uncontrolled asthma. Allergy: European Journal of Allergy and Clinical Immunology
|
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69(suppl99): 441
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arikan-Ayyildiz, Zeynep, Isik, Sakine, Caglayan-Sozmen, Sule
|
|
et al (2016) Efficacy of asthma education program on asthma control in children with uncontrolled asthma. The Turkish journal of pediatrics
|
|
58(4): 383–388
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28276210" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28276210</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Intervention education only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Banasiak, Nancy Cantey (2018) Implementation of the Asthma Control Test in Primary Care to Improve Patient Outcomes. Journal of pediatric health care: official publication of National Association of Pediatric Nurse Associates & Practitioners
|
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32(6): 591–599
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/30104128" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30104128</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Not an RCT. Implementation study with pre/post assessment.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Beerthuizen, Thijs, Rijssenbeek-Nouwens, Lucia H, van Koppen, Sophia M
|
|
et al (2020) Internet-Based Self-Management Support After High-Altitude Climate Treatment for Severe Asthma: Randomized Controlled Trial. Journal of medical Internet research
|
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22(7): e13145
|
|
[<a href="/pmc/articles/PMC7407281/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7407281</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32706692" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32706692</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Study in patients with severe asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Beerthuizen, Thijs, Voorend-van Bergen, Sandra, van den Hout, Wilbert B
|
|
et al (2016) Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial. Thorax
|
|
71(7): 607–13
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/27048197" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27048197</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Same study as Voorend-van Bergen (2015) which is excluded. control group also uses a different frequency and format of ACT.</i>
|
|
</p>
|
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</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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Bergen, S.V., Beerthuizen, T., Van Den Hout, W.
|
|
et al (2015) Cost-effectiveness of FeNO-and web-based monitoring in pediatric asthma management. European Respiratory Journal
|
|
46(suppl59) [<a href="https://pubmed.ncbi.nlm.nih.gov/27048197" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27048197</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bernholm, Katrine Feldballe, Homoe, Anne-Sophie, Meteran, Howraman
|
|
et al (2018) F eNO-based asthma management results in faster improvement of airway hyperresponsiveness. ERJ open research
|
|
4(4) [<a href="/pmc/articles/PMC6168761/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6168761</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30302333" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30302333</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Arms: treatment based on FENO Vs treatment based on ACQ. No usual care comparator</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bodajko-Grochowska, A., Emeryk, A., Markut-Miotla, E.
|
|
et al (2017) Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ)?-validity and responsiveness in children. European Respiratory Journal
|
|
50(supplement61)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bruzzese, J., George, M.R., Liu, J.
|
|
et al (2018) The preliminary impact of a web-based intervention for adolescents with uncontrolled asthma: Results from a randomized pilot trial. American Journal of Respiratory and Critical Care Medicine
|
|
197(meetingabstracts)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cano Fuentes, G, Dastis Bendala, C, Morales Barroso, I
|
|
et al (2014) A randomised clinical trial to evaluate the effectiveness of an educational intervention developed for adult asthmatics in a primary care centre. Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria
|
|
46(3): 117–139 [<a href="/pmc/articles/PMC6983582/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6983582</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24176681" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24176681</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study not reported in English</p>
|
|
<p>
|
|
<i>Article in Spanish</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chen, Jianli and Chen, Yongmin (2021) A nurse-led hierarchical management model for the out-of-hospital management of children with bronchial asthma: a prospective randomized controlled study. American journal of translational research
|
|
13(6): 6488–6497
|
|
[<a href="/pmc/articles/PMC8290709/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8290709</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34306389" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34306389</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cowden, John D, Wilkerson-Amendell, Sharon, Weathers, Laura
|
|
et al (2015) The talking card: Randomized controlled trial of a novel audio-recording tool for asthma control. Allergy and asthma proceedings
|
|
36(5): e86–91
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/26314809" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26314809</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Intervention is not symptom diary/questionnaire</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dardouri, Maha, Sahli, Jihene, Ajmi, Thouraya
|
|
et al (2020) Effect of Family Empowerment Education on Pulmonary Function and Quality of Life of Children With Asthma and Their Parents in Tunisia: A Randomized Controlled Trial. Journal of pediatric nursing
|
|
54: e9–e16
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32616452" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32616452</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dokbua, S, Dilokthornsakul, P, Chaiyakunapruk, N
|
|
et al (2018) Effects of an Asthma Self-Management Support Service Provided by Community Pharmacists: A Systematic Review and Meta-Analysis. Journal of managed care & specialty pharmacy
|
|
24(11): 1184–1196
|
|
[<a href="/pmc/articles/PMC10397854/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10397854</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30362920" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30362920</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review used as source of primary studies</p>
|
|
<p>
|
|
<i>systematic review. Any potentially included studies before 2012 cut-off</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Farouk, R.A., Abdel-Latif, G.A.-R., Dwedar, I.A.
|
|
et al (2023) Validation of asthma management approach according to risk factors. Egyptian Journal of Chest Diseases and Tuberculosis
|
|
72(1): 16–24
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>and incorrect study design: cohort study</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fedele, David A, Janicke, David M, McQuaid, Elizabeth L
|
|
et al (2018) A Behavioral Family Intervention for Children with Overweight and Asthma. Clinical practice in pediatric psychology
|
|
6(3): 259–269
|
|
[<a href="/pmc/articles/PMC6223312/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6223312</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30416909" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30416909</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Federman, A., O'Conor, R., Mindlis, I.
|
|
et al (2018) A comprehensive self-management support program improves asthma control and quality of life among older adults: Results of a randomized controlled trial. American Journal of Respiratory and Critical Care Medicine
|
|
197(meetingabstracts)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Federman, Alex D, O'Conor, Rachel, Mindlis, Irina
|
|
et al (2019) Effect of a Self-management Support Intervention on Asthma Outcomes in Older Adults: The SAMBA Study Randomized Clinical Trial. JAMA internal medicine
|
|
179(8): 1113–1121
|
|
[<a href="/pmc/articles/PMC6563560/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6563560</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31180474" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31180474</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fornell, L.L., Escriche, X.F., Alvarez, S.A.
|
|
et al (2014) Can we improve the follow up of asthmatic patients with asthma educational program (PAMA)?. European Respiratory Journal
|
|
44(suppl58)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gao, Guozhen, Liao, Yaoji, Mo, Lulu
|
|
et al (2020) A randomized controlled trial of a nurse-led education pathway for asthmatic children from outpatient to home. International journal of nursing practice
|
|
26(3): e12823
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32012398" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32012398</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component education intervention that includes asthma diary.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
George, Maureen, Bruzzese, Jean-Marie, Lynn S Sommers, Marilyn
|
|
et al (2021) Group-randomized trial of tailored brief shared decision-making to improve asthma control in urban black adults. Journal of advanced nursing
|
|
77(3): 1501–1517
|
|
[<a href="/pmc/articles/PMC7902417/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7902417</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33249632" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33249632</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gladanac, B., Chen, K., McNab, S.
|
|
et al (2021) Interactive digital technology can improve paediatric asthma control. Respirology
|
|
26(suppl2): 126
|
|
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Grammatopoulou, Eirini Pt
|
|
PhD, Skordilis, Emmanouil K
|
|
PhD, Haniotou, Aikaterini Md
|
|
Fccp
|
|
et al (2017) The effect of a holistic self-management plan on asthma control. Physiotherapy theory and practice
|
|
33(8): 622–633
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28605206" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28605206</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component self-management (eg action plan, education) intervention including instructions on symptoms and PEF monitoring. Not clear that management changed as a result of symptoms monitoring</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Guendelman, S, Meade, K, Chen, YQ
|
|
et al (2004) Asthma control and hospitalizations among inner-city children: results of a randomized trial. Telemedicine journal and e-health
|
|
10suppl2: S-6 [<a href="https://pubmed.ncbi.nlm.nih.gov/23570208" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23570208</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hemati, Z., Shakerian, B., Shirani, F.
|
|
et al (2017) Effect of the orem self-care model on quality of life in adolescents with asthma. Journal of Comprehensive Pediatrics
|
|
8(2): e59343
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hepworth, C., Lilley, A., Gait, L.
|
|
et al (2019) A multidisciplinary community-based complex intervention on children with asthma. European Respiratory Journal
|
|
54(supplement63)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Holley, S., Knibb, R., Latter, S.
|
|
et al (2018) Self-efficacy, asthma control and quality of life in adolescents with asthma taking part in an intervention study. Clinical and Translational Allergy
|
|
8(supplement2)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Holmes, Lucy C, Orom, Heather, Lehman, Heather K
|
|
et al (2022) A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. The Journal of asthma: official journal of the Association for the Care of Asthma
|
|
59(3): 523–535
|
|
[<a href="/pmc/articles/PMC8281495/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8281495</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33322963" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33322963</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Honkoop, P.J., Loymans, R..J.B., Termeer, E.
|
|
et al (2014) Targeting different levels of asthma control by symptom and biomarker driven strategies: A cluster randomised trial in primary care. American Journal of Respiratory and Critical Care Medicine
|
|
189(meetingabstracts)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Honkoop, Persijn J, Loijmans, Rik J B, Termeer, Evelien H
|
|
et al (2015) Symptom- and fraction of exhaled nitric oxide-driven strategies for asthma control: A cluster-randomized trial in primary care. The Journal of allergy and clinical immunology
|
|
135(3): 682–8e11
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25174865" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25174865</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Horner, Sharon D and Brown, Adama (2014) Evaluating the effect of an asthma self-management intervention for rural families. The
|
|
Journal of asthma: official journal of the Association for the Care of Asthma
|
|
51(2): 168–77 [<a href="https://pubmed.ncbi.nlm.nih.gov/24188732" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24188732</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hui, Chi Yan, Walton, Robert, McKinstry, Brian
|
|
et al (2017) The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. Journal of the American Medical Informatics Association: JAMIA
|
|
24(3): 619–632
|
|
[<a href="/pmc/articles/PMC7651908/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7651908</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27694279" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27694279</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Iamlaor, U. and Taneepanichskul, S. (2021) Effectiveness of asthma self-care program through mobile Line application (SALA) on lung function among asthma patients in Angthong Hospital: A randomized control trial. Journal of the Medical Association of Thailand
|
|
104(2): 264–270
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Janssens, T. and Harver, A. (2014) Effect of resistive load training on asthma trigger identification. American Journal of Respiratory and Critical Care Medicine
|
|
189(meetingabstracts)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Jin, H.J., Nam, Y.H., Kim, S.
|
|
et al (2019) Clinical efficacy of information and communication technology based monitoring of asthma: A prospective, randomized controlled, multicenter study. Allergy: European Journal of Allergy and Clinical Immunology
|
|
74(supplement106): 396
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Khdour, M.R.; Hallak, H.O.; Elayyan, S.O. (2020) Pharmaceutical care for adult asthma patients: A controlled intervention one year follow up study. International Journal of Clinical Pharmacy
|
|
42(1): 222 [<a href="https://pubmed.ncbi.nlm.nih.gov/31628887" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31628887</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kim, M.-A., Ye, Y.-M., Park, J.-W.
|
|
et al (2014) A computerized asthma-specific quality of life: A novel tool for reflecting asthma control and predicting exacerbation on behalf of the premier researchers aiming new era in asthma and allergic diseases (PRANA) study group. International Archives of Allergy and Immunology
|
|
163(1): 36–42
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24247849" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24247849</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kim, Mi-Ae, Ye, Young-Min, Park, Jung-Won
|
|
et al (2014) A computerized asthma-specific quality of life: a novel tool for reflecting asthma control and predicting exacerbation. International archives of allergy and immunology
|
|
163(1): 36–42
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24247849" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24247849</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Duplicate reference</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kuipers, Esther, Wensing, Michel, de Smet, Peter
|
|
et al (2017) Self-management research of asthma and good drug use (SMARAGD study): a pilot trial. International journal of clinical pharmacy
|
|
39(4): 888–896
|
|
[<a href="/pmc/articles/PMC5541115/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5541115</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28597176" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28597176</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Study not randomised</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lim, Angelina S, Stewart, Kay, Abramson, Michael J
|
|
et al (2014) Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): a randomized controlled trial. Chest
|
|
145(5): 1046–1054
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24522786" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24522786</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component intervention</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ljungberg, H.; Carleborg, A.; Nordlund, B. (2019) Clinical effect on asthma control using a novel digital selfmanagement solution: A physician blinded randomized controlled crossover trial. European Respiratory Journal
|
|
54(supplement63) [<a href="https://pubmed.ncbi.nlm.nih.gov/31481605" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31481605</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ljungberg, Henrik, Carleborg, Anna, Gerber, Hilmar
|
|
et al (2019) Clinical effect on uncontrolled asthma using a novel digital automated self-management solution: a physician-blinded randomised controlled crossover trial. The European respiratory journal
|
|
54(5) [<a href="https://pubmed.ncbi.nlm.nih.gov/31481605" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31481605</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component digital intervention - electronic symptom monitoring and bluetooth spirometer combined</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lu, L, Lin, RJ, Guan, RZ
|
|
et al (2019) Influence of five-in-one management mode on disease prevention and control of school children with asthma. Zhonghua ER ke za zhi = chinese journal of pediatrics
|
|
57(11): 870–875
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31665842" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31665842</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lu, Mei, Ownby, Dennis R, Zoratti, Edward
|
|
et al (2014) Improving efficiency and reducing costs: Design of an adaptive, seamless, and enriched pragmatic efficacy trial of an online asthma management program. Contemporary clinical trials
|
|
38(1): 19–27
|
|
[<a href="/pmc/articles/PMC4877682/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4877682</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24607295" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24607295</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lv, Shaoxia, Ye, Xiaohong, Wang, Zhijiang
|
|
et al (2019) A randomized controlled trial of a mobile application-assisted nurse-led model used to improve treatment outcomes in children with asthma. Journal of advanced nursing
|
|
75(11): 3058–3067
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31241192" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31241192</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component digital intervention including ‘health diary’, that did communicate with healthcare team. Not clear that health diary included symptom assessment or that care was altered as a result of health diary alone</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Manfrin, A.; Thomas, T.; Krska, J. (2016) Symptom control and adherence are major issues for asthmatic patients: Can they be improved and are they linked?. Pharmacoepidemiology and Drug Safety
|
|
25(supplement2): 18–19
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Manfrin, Andrea; Thomas, Trudy; Krska, Janet (2015) Randomised evaluation of the Italian medicines use review provided by community pharmacists using asthma as a model (RE I-MUR). BMC health services research
|
|
15: 171
|
|
[<a href="/pmc/articles/PMC4422306/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4422306</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25896873" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25896873</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Secondary publication of an included study that does not provide any additional relevant information</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Manfrin, Andrea, Tinelli, Michela, Thomas, Trudy
|
|
et al (2017) A cluster randomised control trial to evaluate the effectiveness and cost-effectiveness of the Italian medicines use review (I-MUR) for asthma patients. BMC health services research
|
|
17(1): 300
|
|
[<a href="/pmc/articles/PMC5404667/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5404667</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28438152" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28438152</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Data not reported in an extractable format or a format that can be analysed</p>
|
|
<p>
|
|
<i>ACT is a study outcome but not clear in paper if the ACT is considered part of intervention. Can exclude due to no usable outcomes as ACT scores (measuring asthma control) were reported as median (IQR) which we can’t meta-analyse. Comparator not usual care.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Martin, S.H., De Heredia, J.H.P., Gomez, M.
|
|
et al (2017) "App" for uncontrolled moderate-severe asthma patients follow-up. European Respiratory Journal
|
|
50(supplement61)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mcdonald, V., Clark, V., Wark, P.
|
|
et al (2017) Multidimensional assessment and targeted therapy of severe asthma: A randomised controlled trial (RCT). European Respiratory Journal
|
|
50(supplement61) [<a href="https://pubmed.ncbi.nlm.nih.gov/31806719" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31806719</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
McDonald, V.M., Clark, V.L., Wark, P.A.B.
|
|
et al (2017) Multidimensional assessment and targeted therapy of severe persistent asthma: A randomised controlled trial. Respirology
|
|
22(supplement2): 66
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Montalbano, Laura, Ferrante, Giuliana, Cilluffo, Giovanna
|
|
et al (2019) Targeting quality of life in asthmatic children: The MyTEP pilot randomized trial. Respiratory medicine
|
|
153: 14–19
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31136927" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31136927</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>MyTEP includes monitoring of symptoms and c-ACT completion as part of a multi-component intervention (eg incl bluetooth spirometer). Also comparator group includes receipt of a health app so judged to be not usual care.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nemanic, Tiva, Sarc, Irena, Skrgat, Sabina
|
|
et al (2019) Telemonitoring in asthma control: a randomized controlled trial. The Journal of asthma: official journal of the Association for the Care of Asthma
|
|
56(7): 782–790
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/30063840" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30063840</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Perron, G., Garcia, M., Carbonnel, F.
|
|
et al (2019) The Childhood Asthma Control Test improves the therapeutic adaptations recommended for asthmatics aged 6 to 11 years in primary practice. A Randomized comparative prospective study. Presse Medicale
|
|
48(9): e257–e266
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31473028" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31473028</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rank, Matthew A, Bertram, Susan, Wollan, Peter
|
|
et al (2014) Comparing the Asthma APGAR system and the Asthma Control Test TM in a multicenter primary care sample. Mayo Clinic proceedings
|
|
89(7): 917–25
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24809759" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24809759</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ravandi, Bahareh, Thompson, Lindsey R, Barry, Frances
|
|
et al (2022) Use of a validated asthma questionnaire to increase inhaled corticosteroid prescribing in the pediatric emergency department. The Journal of asthma: official journal of the Association for the Care of Asthma
|
|
59(2): 378–385
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/33185486" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33185486</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Real, Francis J, Beck, Andrew F, DeBlasio, Dominick
|
|
et al (2019) Dose Matters: A Smartphone Application to Improve Asthma Control Among Patients at an Urban Pediatric Primary Care Clinic. Games for health journal
|
|
8(5): 357–365
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31157983" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31157983</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Reece, E.R.; Burnette, A.F.; Lewis-Land, C.J. (2017) Pilot study of asthmawin mobile iphone app in the management of asthma. Journal of Allergy and Clinical Immunology
|
|
139(2supplement1): ab382
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rhee, Hyekyun; Love, Tanzy; Mammen, Jennifer (2019) Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology
|
|
122(1): 58–64 [<a href="/pmc/articles/PMC6309658/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6309658</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30213611" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30213611</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rijssenbeek-Nouwens, L.H., Beerthuizen, T., Snoeck-Stroband, J.B.
|
|
et al (2019) eHealth self-management support after high-altitude climate treatment (HACT) of severe asthma: A randomised controlled trial. European Respiratory Journal
|
|
54(supplement63) [<a href="/pmc/articles/PMC7407281/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7407281</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32706692" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32706692</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ryan, D, Price, D, Musgrave, SD
|
|
et al (2012) Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ (online)
|
|
344(7854) [<a href="/pmc/articles/PMC3311462/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3311462</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22446569" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22446569</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Multi-component digital intervention including symptom records, drug use and peak flow monitoring. Links to nurse to FUP when in amber or red zones. Comparator was paper version of same monitoring instructions so the trial is only really testing the electronic nature of the monitoring.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Serhal, Sarah, Mitchell, Bernadette, Krass, Ines
|
|
et al (2022) Rethinking the gold standard - The feasibility of randomized controlled trials within health services effectiveness research. Research in social & administrative pharmacy: RSAP
|
|
18(9): 3656–3668
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/35379559" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35379559</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shanmugam, S, Varughese, J, Nair, MAS
|
|
et al (2012) Pharmaceutical care for asthma patients: a Developing Country's Experience. Journal of research in pharmacy practice
|
|
1(2): 66–71
|
|
[<a href="/pmc/articles/PMC4076865/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4076865</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24991592" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24991592</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component intervention: asthma care diary which consists of mainly pictorial representation of asthma, an information leaflet for patients, small briefing on asthma, pictorial representation of the five steps in asthma management, how to use peak flow meter, inhalation techniques for selected inhalation devices, asthma management plan, and asthma symptoms log sheet. Simple provision of a symptom log sheet does not infer that care was modified as a result of it being completed and used by healthcare team. Poor reporting, FUP 29 days so only potential outcome in protocol is PEF</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shdaifat, Mu'min Billah M; Khasawneh, Rawand A; Alefan, Qais (2022) Clinical and economic impact of telemedicine in the management of pediatric asthma in Jordan: a pharmacist-led intervention. The Journal of asthma: official journal of the Association for the Care of Asthma
|
|
59(7): 1452–1462
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/33941032" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33941032</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Snoeck-Stroband, J.B., Beerthuizen, T., Rijssenbeek-Nouwens, L.
|
|
et al (2017) Web-based self-management support after pulmonary rehabilitation of difficult to treat asthma: A randomised controlled trial. European Respiratory Journal
|
|
50(supplement61)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tinelli, Michela; White, John; Manfrin, Andrea (2018) Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider. BMJ open respiratory research
|
|
5(1): e000322 [<a href="/pmc/articles/PMC6203066/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6203066</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30397484" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30397484</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Data not reported in an extractable format or a format that can be analysed</p>
|
|
<p>
|
|
<i>Another analysis of Manfrin et al (2017) which is excluded. ACT outcomes also not extractable and able to meta-analyse.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van Bragt, S., Van Den Bemt, L., Vaessen-Verberne, A.
|
|
et al (2014) Effectiveness of individualized self management support for children with asthma in Dutch outpatient clinics, preliminary results of a randomized controlled trial. European Respiratory Journal
|
|
44(suppl58)
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van Bragt, D., van den Bemt, L. Kievits, Regien et al (2015) PELICAN: a cluster-randomized controlled trial in Dutch general practices to assess a self-management support intervention based on individual goals for children with asthma. The Journal of asthma: official journal of the Association for the Care of Asthma; vol. 52 (no. 2); 211–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25166455" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25166455</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Data not reported in an extractable format or a format that can be analysed</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van Den Wijngaart, L.S., Kievit, W., Roukema, J.
|
|
et al (2016) The virtual asthma clinic for children: A cost-effectiveness analysis. Pediatric Pulmonology
|
|
51(supplement43): 65
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van der Meer, V., van Stel, HF., Bakker, M.J.
|
|
et al (2010) Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study. Respiratory research, vol 11. [<a href="/pmc/articles/PMC2893513/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2893513</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20537124" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20537124</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Secondary publication of an included study that does not provide any additional relevant information</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
van Dijk, Bas C P, Svedsater, Henrik, Heddini, Andreas
|
|
et al (2020) Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review. BMC pulmonary medicine
|
|
20(1): 79
|
|
[<a href="/pmc/articles/PMC7118934/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7118934</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32245451" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32245451</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Van Vliet, D, Van Horck, M, Van De Kant, K
|
|
et al (2014) Electronic monitoring of symptoms and lung function to assess asthma control in children. Annals of allergy, asthma and immunology
|
|
113(3): 257–262 [<a href="https://pubmed.ncbi.nlm.nih.gov/24950912" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24950912</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Not randomised</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Velychko, V.I.; Venher, Y.I.; Lahoda, D.O. (2020) A responsible patient: from theory to practice on a model of a patient with bronchial asthma. Wiadomosci lekarskie (Warsaw, Poland: 1960)
|
|
73(3): 444–448
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32285810" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32285810</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component intervention in 2 arms (asthma school education plus self-monitoring including symptom; medication plus self-monitoring including symptoms) with additional control arm. Not clear that care altered according to self-monitoring of symptoms.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Voorend-van Bergen, S, Vaessen-Verberne, A A, de Jongste, J C
|
|
et al (2015) Asthma control questionnaires in the management of asthma in children: A review. Pediatric pulmonology
|
|
50(2): 202–8
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25187271" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25187271</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Narrative review - useful background only</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Voorend-van
|
|
Bergen, Sandra, Vaessen-Verberne, Anja A, Brackel, Hein J
|
|
et al (2015) Monitoring strategies in children with asthma: a randomised controlled trial. Thorax
|
|
70(6): 543–50 [<a href="https://pubmed.ncbi.nlm.nih.gov/25825006" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25825006</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>
|
|
<i>Treatment adjusted according to 1) ACT monthly web-based Vs 2) ACT 4 monthly clinic - based</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wang, KY, Chian, CF, Lai, HR
|
|
et al (2010) Clinical pharmacist counseling improves outcomes for Taiwanese asthma patients. Pharmacy world & science: PWS
|
|
32(6): 721–729
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/20798988" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20798988</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi=component intervention - only includes vague mention of instruction on the format to record symptoms in a diary.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wen, Tzu-Ning, Lin, Hsueh-Chun, Yeh, Kuo-Wei
|
|
et al (2022) Effectiveness of eAsthmaCare on Symptoms, Childhood Asthma Control Test, and Lung Function among Asthmatic Children. Journal of medical systems
|
|
46(11): 71
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/36161540" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36161540</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Multi-component intervention of eAsthma-care (website self-management intervention, which enabled web-based self-learning) and which includes self-monitoring of symptoms and home PEFR monitoring and does interact with HCPs. Care (by researchers) altered according to symptoms and lung function monitoring, not symptoms alone. Alterations in care based on these in control group also a potential issue.</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wong, Lai-Yan, Chua, Siew-Siang, Husin, Abdul-Rahman
|
|
et al (2017) A pharmacy management service for adults with asthma: a cluster randomised controlled trial. Family practice
|
|
34(5): 564–573
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28472499" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28472499</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr><tr><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yadav, Anita and Thapa, Parbati (2019) Pharmacist Led Intervention on Inhalation Technique among Asthmatic Patients for Improving Quality of Life in a Private Hospital of Nepal. Pulmonary medicine
|
|
2019: 8217901
|
|
[<a href="/pmc/articles/PMC6930739/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6930739</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31915550" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31915550</span></a>]
|
|
</td><td headers="hd_h_niceng245er12.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain an intervention relevant to this review protocol</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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