Introduction The natural course of COPD is characterised by progressive airflow limitation and complicated by the development of systemic consequences and co-morbidities. Daily physical inactivity (DPA) is believed to mediate those systemic consequences or co-morbidities. Recent research demonstrates that even in the early stages of COPD, DPA plays a role in developing systemic consequences and co-morbidities. Hence, interventions that enhance or maintain DPA in this population, such as pulmonary rehabilitation (PR), should be considered. Due to the low accessibility and high cost of PR in a specialised care setting, rehabilitation in primary care could be an added value for patients with less advanced COPD. related problems. Despite the widespread believe in the benefits of PR in a primary care setting, it remains unclear if such PR programmes are (cost) effective for patients with less advanced COPD
Objective To evaluate data from clinical trials assessing the effect of PR in primary care for patients with less advanced COPD on DPA, exercise capacity (EC) and quality-of-life (QoL).
Methods The electronic databases PEDro, CENTRAL, Pubmed and EMBASE were searched. Only randomised and controlled clinical trials were eligible for inclusion, provided they investigated the effects of interdisciplinary PR in primary care for patients with less advanced COPD (GOLD I-II). Independent data extraction was performed by two authors. Risk of bias was rated using the Cochrane Collaboration ‘Risk of bias’ tool. Primary outcome is the level of DPA, secondary outcomes are EC and QoL.
Results Eight studies were found and methodological quality is displayed in table 1. One study objectively measured DPA by a pedometer and showed a significant improvement in DPA. EC was significantly improved in 7/8 studies. QoL is measured in all 8 studies, 3/8 had a significant improvement and two revealed to have clinical relevant effect on QoL.
Conclusions PR in primary care for patients with less advanced COPD improves EC and QoL and could be beneficial in improving DPA. Since recent insights in the systemic burden of COPD and the role of DPA in this matter, future research must focus on the transfer of PR benefits to DPA, including a cost-effective analysis.