A feasibility trial of pulmonary rehabilitation for patients with COPD in a low resource setting: Jaffna, Sri Lanka

Mathanki Sooriyakanthan; Mark W Orme; Kanagasabai Sivapalan; Gowry Selvaratnam; Sally J Singh; Savithri Wimalasekera

doi:10.1186/s12890-022-02092-x

A feasibility trial of pulmonary rehabilitation for patients with COPD in a low resource setting: Jaffna, Sri Lanka

BMC Pulm Med. 2022 Aug 8;22(1):302. doi: 10.1186/s12890-022-02092-x.

Authors

Mathanki Sooriyakanthan¹, Mark W Orme^{2

3}, Kanagasabai Sivapalan⁴, Gowry Selvaratnam⁵, Sally J Singh^{2

3}, Savithri Wimalasekera⁶

Affiliations

¹ Department of Physiology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka. bsmmathanki@gmail.com.
² Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³ Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁴ Department of Physiology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
⁵ Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
⁶ Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Jaffna, Sri Lanka.

Abstract

Background: Pulmonary rehabilitation is recommended for most patients with chronic obstructive pulmonary disease (COPD). Accordingly, the aim of this study was to explore the feasibility of devising a pulmonary rehabilitation program for patients with COPD in a low resource setting (Jaffna, Sri Lanka) and to observe its effects.

Methods: Non-randomized controlled feasibility trial of ambulatory patients with COPD attending the pulmonary outpatient clinic of the Jaffna Teaching Hospital, Northern Province, Sri Lanka. Age-matched patients were allocated alternatively to an intervention group or to a control group. Twice weekly, for six weeks, patients in the intervention group attended pulmonary rehabilitation sessions consisting of supervised stretching, aerobic and strengthening exercises, and patient-education. Before and at the conclusion of the study, all patients performed incremental shuttle walking test (ISWT), 6-min walk test (6MWT) and completed the Medical Research Council (MRC) dyspnea scale, COPD assessment test (CAT), chronic COPD questionnaire (CCQ), and hospital anxiety depression scale (HADS).

Results: 204 patients with COPD (94% males) were identified at screening; 136 (66.7%) were eligible for pulmonary rehabilitation and 96 patients (47%) consented to participate. Of these, 54 patients (53 males) eventually participated in the study (42 patients were discouraged to participate by family members or friends); 40 patients (20 in the rehabilitation group and 20 patients in the control group) completed the study. Baseline characteristics of the intervention group and the control group were similar. 95% of patients in the intervention group adhered to regular home training exercises (self-reported diary). At post assessment, only the intervention group experienced clinically-meaningful improvements in symptoms and exercise capacity.

Conclusion: A simple and clinically beneficial pulmonary rehabilitation program for patients with COPD can be effectively implemented in a low resource setting. However, there is a need for educating patients and the local community on the benefits of pulmonary rehabilitation to enhance uptake. Retrospective Trial Registration date and number: 16/04/2021, ISRCTN10069208.

Keywords: COPD; Education; Exercise; Feasibility; Low- and middle-income countries; Pulmonary rehabilitation.

Publication types

Controlled Clinical Trial

MeSH terms

Exercise Therapy
Feasibility Studies
Female
Humans
Male
Pulmonary Disease, Chronic Obstructive*
Quality of Life*
Retrospective Studies
Sri Lanka

Associated data

ISRCTN/ISRCTN10069208

Abstract

Publication types

MeSH terms

Associated data

Grants and funding