Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD

Marisela Barbosa; Renato Andrade; Cristina Argel de Melo; Rui Torres

doi:10.4187/respcare.09627

Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD

Respir Care. 2022 May;67(5):579-593. doi: 10.4187/respcare.09627.

Authors

Marisela Barbosa, Renato Andrade, Cristina Argel de Melo, Rui Torres¹

Affiliation

¹ Ms Barbosa is affiliated with Gaia/Espinho Hospital Center, North Rehabilitation Center, Gaia, Portugal; and Câmara Municipal de Arouca, Complexo Municipal Desportivo de Arouca e Piscinas Municipais de Escariz. Mr Andrade is affiliated with Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; and Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto Portugal. Dr de Melo is affiliated with School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal; and CIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal. Dr Torres is affiliated with CESPU, North Polytechnic Institute of Health, Paredes, Portugal; and CIR, Center for Rehabilitation Research, Polytechnic Institute of Porto, Porto, Portugal.

PMID: 35473839
DOI: 10.4187/respcare.09627

Abstract

Background: Community-based pulmonary rehabilitation (PR) programs can be offered to patients with COPD, but the literature on its effects is still not well summarized. Our purpose was to investigate the health-, physical-, and respiratory-related effects of community-based PR in individuals with COPD as compared to control groups.

Methods: The PubMed and Embase databases were searched up to May 17, 2021. We included randomized control trials that compared the effects of community-based PR as compared to control groups in individuals with COPD. The risk of bias was judged using the Cochrane Risk of Bias 2 (RoB2). Meta-analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with 95% CI of the mean changes from baseline between groups. The Grading of Recommendations Assessment, Development, and Evaluation was used to interpret certainty of results.

Results: We included 10 randomized control studies comprising a total of 9,350 participants with weighted mean age of 62.3 ± 2.38 y. The community-based interventions were based on exercise programs (resistance and/or endurance). All studies were judged as high risk and/or some concerns in one or more domains the risk of bias. All meta-analyses displayed very low certainty of evidence. The community-based PR interventions were significantly superior to control interventions in improving the St. George Respiratory Questionnaire Activity subscore (-0.40 [95% CI -0.72 to -0.08]; k = 5, n = 382) and total score (-0.73 [95% CI -1.29 to -0.18]; k = 4, n = 268) and the Chronic Respiratory Disease Questionnaire dyspnea subscore (0.36 [95% CI 0.03-0.69]; k = 6, n = 550). The mean changes from baseline were not different between the groups for all other outcomes.

Conclusions: Community-based PR tended to result in superior health-related quality of life and symptoms than control interventions, but the findings were inconsistent across outcomes and with very low certainty of evidence. Further studies are warranted for stronger conclusions.

Keywords: COPD; community based; exercise; meta-analysis; pulmonary rehabilitation; systematic review.

Publication types

Meta-Analysis
Review

MeSH terms

Dyspnea
Exercise Tolerance
Humans
Middle Aged
Pulmonary Disease, Chronic Obstructive* / rehabilitation
Quality of Life*
Surveys and Questionnaires