Table 3 Summary of findings (SoF) of meta-analysis using Working Group Grades of Evidence (GRADE).

From: Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers – systematic review and meta-analysis

Outcomes	Absolute Effect		Relative effect (95% CI)	Number of studies	Certainty of the evidence (GRADE)^a
Outcomes	Without education	With education	Relative effect (95% CI)	Number of studies	Certainty of the evidence (GRADE)^a
Occurrence of critical errors (DPI device) after education in form of demonstration	59 per 226	15 per 226	RR 0.28 [0.17, 0.47]	1 study dividend into 4	⊕⊕⊕⊖ Moderate^b
	Difference: 44 less errors 0.19 (95% CI: 0.26 to 0.13 more)^a		RR 0.28 [0.17, 0.47]	1 study dividend into 4	⊕⊕⊕⊖ Moderate^b
Occurrence of any incorrect use events (DPI device) after education in form of verbal TTG	18 per 46	11 per 46	RR 0.62 [0.33, 1.16]	1 study divided into 2	⊕⊕⊕⊖ Moderate^b
	Difference: 7 less errors 0.15 (95% CI: 0.34 to 0 fewer)^a		RR 0.62 [0.33, 1.16]	1 study divided into 2	⊕⊕⊕⊖ Moderate^b
Occurrence of any incorrect use events (DPI device) after education in form of video TTG	26 per 52	2 per 52	RR 0.11 [0.02, 0.61]	1 study divided into 2	⊕⊕⊕⊖ Moderate^b
	Difference: 24 less errors 0.46 (95% CI: 0.61 to 0.32 more)^a		RR 0.11 [0.02, 0.61]	1 study divided into 2	⊕⊕⊕⊖ Moderate^b
Occurrence of any incorrect use events (DPI device) after education in form of TTG	21 per 28	3 per 28	RR 0.17 [0.03, 0.97]	2	⊕⊕⊕⊖ Moderate^c
	Difference: 18 less errors 0.64 (95% CI: 0.84 to 0.45 more)^a		RR 0.17 [0.03, 0.97]	2	⊕⊕⊕⊖ Moderate^c
Occurrence of any incorrect use events (DPI device) after education in form of BI	24 per 28	19 per 28	RR 0.82 [0.57, 1.19]	2	⊕⊕⊕⊖ Moderate^c
	Difference: 5 less errors 0.18 (95% CI: 0.39 to 0 fewer)^a		RR 0.82 [0.57, 1.19]	2	⊕⊕⊕⊖ Moderate^c
Occurrence of any incorrect use events (DPI device) after education in form of face to face method	76 per 321	12 per 146	RR 0.31 [0.07, 1.34]	2	⊕⊖⊖⊖ Very low^d
	Difference: 64 less errors 0.15 (95% CI: 0.22 to 0.09 more)^a		RR 0.31 [0.07, 1.34]	2	⊕⊖⊖⊖ Very low^d
Occurrence of any incorrect use events (pMDI/MDI device) after education in form of face to face method	64 per 125	16 per 111	RR 0.28 [0.17, 0.45]	2	⊕⊕⊖⊖ Low^e
	Difference: 48 less errors 0.37 (95% CI: 0.48 to 0.26 more)^a		RR 0.28 [0.17, 0.45]	2	⊕⊕⊖⊖ Low^e
Occurrence of any incorrect use events (pMDI/MDI device) after education in form of demonstration/training	101 per 225	9 per 225	RR 0.09 [0.05, 0.17]	2	⊕⊖⊖⊖ Very low^f
	Difference: 92 less errors 0.41 (95% CI: 0.48 to 0.34 more)^a		RR 0.09 [0.05, 0.17]	2	⊕⊖⊖⊖ Very low^f

95% CI 95% confidence interval, RR risk ratio, GRADE working group grades of evidence.
^aThe confidence interval was calculated from the difference in the proportion of the number of errors in the inhalation technique before and after education.
Explanations.
^bThe evidence was downgraded from a high to moderate rating because of a risk of bias due unclear blinding and allocation concealment. The score was then upgraded by one due to the strong association between the included outcomes and the absence of likely plausible factors.
^cThe evidence was downgraded from a high to moderate rating because of a risk of bias due unclear random sequence generation, blinding and allocation concealment.
^dThe evidence was downgraded from a high to very low rating because of non-randomised evidence and serious inconsistency (large heterogeneity I² = 83%, P value [P = 0.01] due to too many participants in one of the groups, which may distort the results.
^eThe evidence was downgraded from a high to low rating because of non-randomised evidence.
^fThe evidence was downgraded from a high to very low rating because of non-randomised evidence and unexplained serious inconsistency (large heterogeneity I² = 92%, P value [P < 0.0003].

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Table 3 Summary of findings (SoF) of meta-analysis using Working Group Grades of Evidence (GRADE).

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