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Original research
Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis
  1. Alex R Jenkins1,
  2. Chris Burtin2,3,
  3. Pat G Camp4,5,
  4. Peter Lindenauer6,
  5. Brian Carlin7,
  6. Jennifer A Alison8,9,
  7. Carolyn Rochester10,11,
  8. Anne E Holland12,13,14
  1. 1 Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada
  2. 2 REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
  3. 3 BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
  4. 4 Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  5. 5 Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  6. 6 Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School – Baystate, Springfield, MA, USA
  7. 7 Sleep Medicine and Lung Health Consultants, Pittsburgh, Pennsylvania, USA
  8. 8 Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  9. 9 Allied Health, Sydney Local Health District, Sydney, NSW, Australia
  10. 10 Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
  11. 11 VA Connecticut Healthcare System, West Haven, CT, USA
  12. 12 Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
  13. 13 Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
  14. 14 Institute for Breathing and Sleep, Heidelberg, VIC, Australia
  1. Correspondence to Dr Alex R Jenkins, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada; alex.jenkins1108{at}outlook.com

Abstract

Introduction Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD.

Methods An update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method.

Results Seventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I2=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I2=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I2=81%), health-related quality of life (St. George’s Respiratory Questionnaire, MD −8.7 points, 95% CI −12.5 to −4.9, I2=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I2=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I2=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I2=87%; modified Medical Research Council Dyspnoea Scale, MD −0.3 points, 95% CI −0.5 to −0.1, I2=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported.

Discussion Pulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events.

Trial registration number CRD42023406397.

  • pulmonary rehabilitation
  • COPD exacerbations
  • exercise

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • X @AJ_COPD

  • Contributors ARJ: Guarantor of the project, design of the project, participation in acquisition: preparing of search strategy, title and abstract screening, full-text screening, data extraction and analysis, quality assessment and drafting of manuscript. CB: Design of the project, participation in acquisition: title and abstract screening, full-text screening, quality assessment, drafting of manuscript. PGC: Design of the project, participation in acquisition: title and abstract screening, full-text screening, quality assessment, drafting of manuscript. PL: Design of the project, participation in acquisition: title and abstract screening, full-text screening, data extraction, drafting of manuscript. BWC: Conception and design of the project, drafting of manuscript, verification and supervision over the project. JAA: Conception and design of the project, preparing of search strategy, full-text screening, drafting of manuscript, verification and supervision over the project. CR: Conception and design of the project, drafting of manuscript, verification and supervision over the project. AEH: Conception and design of the project, preparing of search strategy, data analysis, drafting of manuscript, verification and supervision over the project.

  • Funding This review was funded by the American Thoracic Society as part of a clinical practice guideline.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.