Benefits Of Pulmonary Rehabilitation Research Articles

Factors related to the implementation of pulmonary rehabilitation in Jordan: Perspective of healthcare professionals

BackgroundAlthough the benefits of pulmonary rehabilitation (PR) in the management of chronic respiratory disease conditions (CRC) are well-documented, it remains underutilized. In Jordan, the scarcity of PR services denies those with CRC the opportunity to improve their functional capacity, mental health, and quality of life. ObjectiveTo explore the factors related to the implementation of PR in Jordan from the perspective of the healthcare professionals (HCPs). MethodsThis was a qualitative study that utilized semi-structured interviews informed by the Theoretical Domains Framework (TDF). Twenty-one HCPs were interviewed. Interview transcripts were coded against the relevant TDF domain(s) and then domains’ summaries were generated. ResultsA total of 997 quotes were coded against the TDF domains. Knowledge, environmental context and resources, social influences, and skills domains were the ones most coded. The study identified several barriers to PR implementation such as: limited knowledge and skills pertaining to PR among HCPs, limited public awareness of PR, financial costs, limited legislation related to establishment of PR and role confusion of HCPs in PR. The main facilitators include: HCPs willingness to be involved in new programs such as PR, the perception of the importance and need for PR and HCPs beliefs about capabilities to overcome barriers for a successful implementation of PR. ConclusionThe current study provided information that will inform stakeholders and policymakers about the factors affecting PR implementation in Jordan. Improvements in HCPs skills and knowledge about PR, financial support, improvements in undergraduate syllabi and policies to control PR service provision are considered to be key to a successful implementation of PR.

Managing chronic obstructive pulmonary disease in primary health care: the impact of pulmonary rehabilitation

Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and its management involves improving quality of life, delaying progression, and minimizing exacerbations. The benefit of pulmonary rehabilitation in COPD has been documented in the literature. This intervention can be applied to a primary healthcare setting, using community resources. Objectives: This systematic review sought to compile current evidence implying the impact of pulmonary rehabilitation in a primary healthcare setting on the quality of life of patients with COPD. Methods: Three databases were searched for randomized controlled trials. We included community-based pulmonary rehabilitation and excluded interventions in a hospital setting. The primary outcome was health-related quality of life; secondary outcomes were functional exercise capacity and mortality. Data extraction and triage were performed independently by three authors, and bias was evaluated using the Cochrane Risk of Bias Tool. Results: Four studies met the search criteria. Three studies reported benefits in at least one of the outcomes; a fourth reported no differences between groups. Rehabilitation frequency and duration seemed to have some impact on all outcomes. Mortality was higher in the control groups when available. The included studies had important limitations, namely the inability to blind interventions. Conclusions: Pulmonary rehabilitation in a primary health care setting benefits the quality of life and functional exercise capacity in COPD patients. Optimal treatment modality, frequency, and duration are yet to be defined and are perhaps reliant on individual patient attributes. Though unable to add to previous findings, we hope this review fosters interest in this potentially life-changing intervention in a primary healthcare context.

Optimizing individual benefits of pulmonary rehabilitation including a multifaceted dietary intervention – A single-arm feasibility study

Optimizing individual benefits of pulmonary rehabilitation including a multifaceted dietary intervention – A single-arm feasibility study

Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline.

Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.

Modern approaches of rehabilitation in COPD patients

Chronic Obstructive Pulmonary Disease (COPD) presents a significant challenge to public health, impairing the quality of life for affected individuals. Traditionally, the management of COPD primarily involved pharmacological interventions and symptom management, but a shift towards comprehensive rehabilitation programs has been observed in recent times. This study focuses on exploring these modern approaches to COPD rehabilitation, including exercise training, education, psychosocial support, and self-management strategies. By emphasizing patient-centered and multidisciplinary methodologies, modern rehabilitation approaches aim to address the individual needs of COPD patients. Previous studies affirm the positive impacts of these comprehensive programs, including improved exercise capacity, reduced symptoms, and enhanced overall well-being. This current investigation aims to further analyze the effects of various pulmonary rehabilitation methods on COPD management within a modern medical context. By critically evaluating literature and research databases like SCOPUS, PubMed, SciELO, Google Scholar, and Cochrane Library, this study seeks to provide unique insights into the efficacy and benefits of pulmonary rehabilitation for COPD patients. The implications of this research could contribute significantly to evidence-based practices, assisting healthcare professionals in optimizing the selection and implementation of pulmonary rehabilitation interventions for improved patient outcomes.

Effects of Preoperative High-Intensity Interval Training Combined With Team Empowerment Education in Lung Cancer Patients With Surgery: A Quasi-experimental Trial.

Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients. This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection. This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay. Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups. This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms. This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.

Pre-conference workshop on pulmonary rehabilitation and smoking cessation – NATCON 2022

The 77th National Conference of Tuberculosis and Chest Diseases was held on 27th February 2023. The workshop on Pulmonary rehabilitation and smoking cessation was conducted as a part of the various pre-conference workshops being conducted on the occasion. It helped the participants to know regarding the role, efficacy and benefits of pulmonary rehabilitation and smoking cessation for the management of Chronic respiratory diseases.

Current Perspectives and Future Directions of Repeat Pulmonary Rehabilitation Programmes in People with Chronic Obstructive Pulmonary Disease: A Narrative Review of the Literature

The benefits of pulmonary rehabilitation (PR) diminish over 12–24 months following programme completion. A repeat PR programme may potentially prevent or reverse this decline in gains and may provide additional benefits. The aim of this narrative review was to discuss the current available evidence regarding repeat PR programmes and provide perspectives on unresolved questions, future areas of inquiry, and suggestions for clinical practice. Randomised controlled trials showed PR repeated at 6, 12, or 24 months after the initial PR programme resulted in similar short-term improvements in exercise capacity and quality of life; however, they did not result in long-term benefits beyond 12–24 months. In uncontrolled studies, the improvements in exercise capacity achieved following repeat PR were of a smaller magnitude than after the initial PR programme, but the improvements were still clinically significant. There is limited evidence to guide the optimal timing and characteristics of a repeat PR programme, such as frequency, duration and content, as well as which patients may benefit. There are ethical factors to consider in offering repeat PR programmes, including availability and access, the impact on resources and capacity of PR programmes, and patient-related factors such as financial burden and difficulties with transport. Alternate means of delivering a repeat PR programme should be explored, especially with emerging evidence for home-based PR and telerehabilitation programmes. A modular approach to a repeat PR programme by offering only certain elements rather than a comprehensive programme may also address the aspects of access, resources, capacity, and patient burden.

Benefits of Pulmonary Rehabilitation in Post COVID Patients: A Retrospective Study

Background: COVID-19 disease has spread worldwide irrespective of age, gender and comorbidities. lung is the main affecting organ in corona virus disease due to which patients infected with covid19 has impacting on exercise tolerance, quality of life and dyspnoea. Purpose: to observe the effects of pulmonary rehabilitation in post covid patients. Objectives: to observe the effects of pulmonary rehabilitation of dyspnoea by MMRC scale and exercise tolerance by 6min walk test in post covid patients. Methodology: A total of 61 patients meeting the inclusion and exclusion criteria. dyspnoea and exercise tolerance score has recorded before and after the pulmonary rehabilitation. Result: post pulmonary rehabilitation score in terms of dyspnoea and exercise tolerance has showed extremely significant improvement (p<0.001) as compared to pre pulmonary rehabilitation score. Conclusion: pulmonary rehabilitation is effective in improving dyspnoea and exercise tolerance in post covid patients. KEYWORDS: Pulmonary Rehabilitation, COVID-19, Exercise Tolerance, Dyspnoea.

Benefits of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis Receiving Antifibrotic Drug Treatment.

Background: Although patients with idiopathic pulmonary fibrosis (IPF) often receive treatment with antifibrotic drugs (AFDs) and pulmonary rehabilitation (PR) concurrently, there are no reports on the effect of PR on patients with IPF receiving AFDs. Therefore, we investigated the effect of PR on patients with IPF receiving AFDs. Methods: Eighty-seven eligible patients with IPF (61 male; 72.0 ± 8.1 years; GAP severity stage I/II/III: 26/32/12) were recruited for the study. Patients who completed a 3-month outpatient PR program and those who did not participate were classified into four groups according to use of AFDs: PR group (n = 29), PR+AFD group (n = 11), treatment-free observational group (control group; n = 26), and AFD group (n = 21). There was no significant difference in age, sex, or severity among the groups. Patients were evaluated for physical functions such as 6-min walk distance (6MWD) and muscle strength, dyspnea, and health-related quality of life (HRQOL) at baseline and at 3 months. Results: In the PR group, dyspnea and 6MWD showed significant improvement after the 3-month PR program (p < 0.05 and p < 0.01, respectively). HRQOL was significantly worse at 3 months (p < 0.05) in the AFD group, but not in the other groups. The change in 6MWD from baseline to the 3-month time point was significantly higher in the PR+AFD group than in the AFD groups (p < 0.01). Conclusions: It was suggested that AFD treatment reduced exercise tolerance and HRQOL at 3 months; however, the concurrent use of PR may prevent or mitigate these effects.

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

BackgroundPulmonary 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.MethodsNon-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).Results204 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.ConclusionA 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.

Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol)

BackgroundStrong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD.MethodsMulti-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. Outcomes: AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests.DiscussionPulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False

Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial

IntroductionThere is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent...

Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

<scp>Multi‐disciplinary</scp> collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with <scp>post‐acute</scp> sequelae of <scp>SARS‐CoV</scp>‐2 infection (<scp>PASC</scp>)

Saudi Physicians' Awareness and Practice of Pulmonary Rehabilitation for Post-COVID-19 Syndrome Patients

Background: The coronavirus disease (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, has resulted in considerable mortality, morbidity, and unprecedented strain on healthcare systems throughout the world. As the pandemic evolves, one of those challenges has become increasingly common - the post-COVID-19 syndrome. Approximately 10-20% of SARS-CoV-2 patients who experienced an acute symptomatic phase are still experiencing some effects beyond 12 weeks. To assess knowledge, awareness and practice about effectiveness and benefits of pulmonary rehabilitation for post-covid-19 syndrome patients and their practical barriers and opportunities, and education and training needs among Saudi physicians.&#x0D; Methodology: A cross-sectional online survey was held among healthcare providers in Saudi Arabia. Department of internal medicine, Heraa General Hospital, between January 2021 and November 2021. The questionnaire was sent to Saudi physicians from data collectors face-to-face through smartphone apps. The questionnaire covered the talk about pulmonary rehabilitation knowledge and familiarity among Saudi physicians, support and practice, barriers to pulmonary rehabilitation integration, and interest in learning more about pulmonary rehabilitation programs.&#x0D; Results: A total of 1111 responded to the survey. The mean age of the participants was 33 years old, with mean years of experience of about 6.95 years. The majority of respondents (n=949) (85.4%) work in urban areas and come from various regions, including the west (n=407) (36.6%), east (n=195) (17.6%), north (n=150) (13.5%), south (n=150) (13.5%) and central region (n=209) (18.8%). More than half of the respondents were physicians (n=750) (67.5%) from different specialties, and the mean number of covid-19 patients seen by physicians was 5.68% per day.&#x0D; Conclusion: Participants in this study showed a positive attitude toward pulmonary rehabilitation. They believe their patients would benefit from Pulmonary rehabilitation, are interested in referring post-covid-19 patients to rehabilitation providers and co-managing their care, and would like more educational opportunities in order to increase their knowledge of the safety and efficacy of pulmonary rehabilitation.

Maintenance of pulmonary rehabilitation benefits in patients with COPD: is a structured 5-year follow-up program helpful?

Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George’s respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Long-term randomized controlled studies are needed to verify these results.

Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and COPD: A Propensity-Matched Real-World Study

BackgroundThe adherence to and clinical efficacy of pulmonary rehabilitation in idiopathic pulmonary fibrosis (IPF), particularly in comparison with COPD, remains uncertain. The objectives of this real-world study were to compare the responses of patients with IPF with a matched group of patients with COPD undergoing the same supervised, outpatient pulmonary rehabilitation program and to determine whether pulmonary rehabilitation is associated with survival in IPF.Research QuestionDo people with IPF improve to the same extent with pulmonary rehabilitation as a matched group of individuals with COPD, and are noncompletion of or nonresponse to pulmonary rehabilitation, or both, associated with 1-year all-cause mortality in IPF?Study Design and MethodsUsing propensity score matching, 163 patients with IPF were matched 1:1 with a control group of 163 patients with COPD referred for pulmonary rehabilitation. We compared between-group pulmonary rehabilitation completion rates and response. Survival status in the IPF cohort was recorded over 1 year after pulmonary rehabilitation discharge. Cox proportional hazards regression explored the association between pulmonary rehabilitation status and all-cause mortality.ResultsSimilar pulmonary rehabilitation completion rates (IPF, 69%; COPD, 63%; P = .24) and improvements in exercise response were observed in both groups with no significant mean between-group differences in incremental shuttle walk test (ISWT) change (mean, 2 m [95% CI, –18 to 22 m]). Pulmonary rehabilitation noncompletion (hazard ratio [HR], 5.62 [95% CI, 2.24-14.08]) and nonresponse (HR, 3.91 [95% CI, 1.54-9.93]) were associated independently with increased 1-year all-cause mortality in IPF.InterpretationThis real-word study demonstrated that patients with IPF have similar completion rates and magnitude of response to pulmonary rehabilitation compared with a matched group of patients with COPD. In IPF, noncompletion of and nonresponse to pulmonary rehabilitation were associated with increased all-cause mortality. These data reinforce the benefits of pulmonary rehabilitation in patients with IPF.

The Impact of Depression and Exercise Self-Efficacy on Benefits of Pulmonary Rehabilitation in Veterans with COPD

Pulmonary rehabilitation (PR) improves health-related quality of life (HRQoL) and exercise capacity. Little is known about the impact of depression symptoms and exercise self-efficacy on improvements in these key PR outcomes. This study examined the impact of baseline depression status and change in depression symptoms (Beck Depression Inventory-II [BDI-II] score) over the course of PR on change in HRQoL assessed by the Chronic Respiratory Disease Questionnaire-Self Reported (CRQ-SR) and exercise capacity as measured by the 6-Minute Walk Test (6MWT). We also examined whether baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in these key PR outcomes. We studied 112 US veterans (aged 70.38 ± 8.49 years) with chronic obstructive pulmonary disease (COPD) who completed PR consisting of twice-weekly 2-hour classes for 18 sessions. Depressed (BDI-II >13) and nondepressed (BDI-II ≤13) patients at baseline demonstrated comparable and significant improvement in CRQ-SR total score, subscales, and 6MWT. Greater reduction in depression over the course of treatment was significantly associated with greater improvement in CRQ-SR total score and the following subscales: fatigue, mastery, and emotional function. Change in depression did not predict change in 6MWT distance. Baseline exercise self-efficacy moderated the association between baseline depression symptoms and change in CRQ-SR fatigue. Specifically, when baseline exercise self-efficacy was <30.4, greater baseline depression was associated with less improvement in CRQ-SR fatigue. When baseline self-efficacy was >152.0, greater baseline depression was associated with greater improvement in CRQ-SR fatigue. PR programs should address mood and confidence to exercise given their impact on key PR outcomes.

Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease.

Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.

Pulmonary rehabilitation in long COVID: more than just natural recovery!?

In the light of missing randomised controlled trials, some arguments suggest that pulmonary rehabilitation has beneficial effects beyond natural recovery https://bit.ly/3ze2xvw