Pulmonary rehabilitation for chronic obstructive pulmonary disease
Abstract
Background
The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115‐1119 (Lacasse 1996).
Objectives
To determine the impact of rehabilitation on health‐related quality of life (QoL) and exercise capacity in patients with COPD.
Search methods
We included the 14 randomized controlled trials (RCTs) in the original meta‐analysis. We identified additional RCTs from the Cochrane Airways Group COPD trial registry using the strategy: [exp, lung diseases, obstructive] and [exp, rehabilitation or exp, exercise therapy] and [research design or longitudinal studies or evaluation study or randomized controlled trial]. We also searched abstracts presented at the American Thoracic Society 1980 to 2000, American College of Chest Physicians 1980 to 2000 and European Respiratory Society 1987 to 2000.
Selection criteria
RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least four weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation.
Data collection and analysis
We calculated weighted mean differences (WMD) using a random effects model. We requested missing data from the authors of the primary study.
Main results
23 RCTs met the inclusion criteria. We found statistically significant improvements for all the outcomes. In three important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units using this instrument. For example Dyspnoea score: WMD 0.98 units, 95% Confidence Interval (95% CI) 0.74 to 1.22 units; n = 9 trials. For FEC and MEC, the effect was small and a little below the threshold of clinical significance for the six‐ minute walking distance: WMD 49 m, 95% CI: 26 to 72 m; n = 10 trials.
Authors' conclusions
Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD.
PICOs
Plain language summary
We published a meta‐analysis of respiratory rehabilitation in chronic obstructive pulmonary disease that was not conducted under the patronage of the Cochrane Collaboration (Lacasse 1996). We report here its update.
We wished to determine the impact of rehabilitation (defined as exercise training for at least four weeks with or without education and/or psychological support) on quality of life (QoL) and exercise capacity. We included 23 RCTs. Statistically significant improvements were found for all the outcomes. In three important domains of QoL (dyspnea, fatigue and patients' control over disease), the effect was larger than the minimal clinically important difference.
