Using GRADEpro to create Evidence Profiles and Summary of Findings Tables

1. Using GRADEpro to create Evidence Profiles and Summary of Findings Tables Wednesday 19 January 2011 1200 to 1330 (PT) Nancy Santesso McMaster University

2. Evidence profiles • Guideline panels are working from the • same evidence • transparently provided • Recommendations can be based on • the quality of the evidence • the summarised effects of an intervention • Estimated effects of an intervention

3. Evidence profiles • Is a summary of the key findings of the evidence • Presents • the quality of the evidence • the effects • reasons behind decisions

4. Format of evidence profiles • PICO • Outcomes • Results • Participants and studies • Relative effects • Absolute effects • Quality of the Evidence • Comments and Footnotes

5. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

6. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

7. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

8. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

9. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

10. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

11. Question: Should self management vs usual care be used for chronic obstructive pulmonary disease?1Settings: primary care, community, outpatientBibliography: Effing TTW, Monninkhof EEM, van derValk PP.D.L.P.M., van derPalen JJ, van Herwaarden CLA, Partidge MR, Walters HEH, Walters EH, Zielhuis GG.A.. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007, Issue 4. 1 Self-management is a term applied to any formalized patient education programme aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. Of the 14 studies, there were four in which the education delivery mode consisted of group education; nine which were individual education and one study which was written education material only. In six studies the use of an action plan for self-treatment of exacerbations was assessed.2 Seven other studies were not pooled and some showed non-significant effects.3 No allocation concealment in 1 study. Incomplete follow-up.4 Sparse data. 5 Different definitions of exacerbations used and studies could not be pooled.6 Two studies with very severe COPD patients weighted heavily in meta-analysis. Therefore, there is some uncertainty with the applicability of effect to all risk groups.7 The low and high risk values are the two extreme numbers of admissions in the control groups from two studies (8% was rounded to 10% and 51% to 50%). 8 Unexplained heterogeneity.

12. Before you start... • Systematic review is done (analyses done) • Decide on the clinical question to present • One population • One intervention • One comparison • Choose critical and important outcomes