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Pulmonary rehabilitation for chronic obstructive pulmonary disease.

Abstract

BACKGROUND

The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115-1119.

OBJECTIVES

To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD.

SEARCH STRATEGY

The 14 randomized controlled trials (RCTs) included in the original meta-analysis were included. Additional RCTs were identified from the Cochrane Airways Group's registry of COPD RCTs using the strategy: [exp, lung diseases, obstructive] and [exp, rehabilitation or exp, exercise therapy] and [research design or longitudinal studies or evaluation study or randomized controlled trial]. Abstracts presented at American Thoracic Society 1980-2000, American College of Chest Physicians 1980-2000 and European Respiratory Society 1987-2000 were also searched.

SELECTION CRITERIA

RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least 4 weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation.

DATA COLLECTION AND ANALYSIS

Weighted mean differences (WMD) were calculated using a random-effects model. Missing data from the primary study reports were requested from the authors.

MAIN RESULTS

23 RCTs met the inclusion criteria. Statistically significant improvements were found for all the outcomes. In three important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units using this instrument. For example Dyspnoea score: WMD 0.98 units, 95% Confidence Interval (95% CI) 0.74 - 1.22 units; n=9 trials. For FEC and MEC, the effect was small and a little below the threshold of clinical significance for the 6- minute walking distance: WMD 49 m, 95% CI: 26 - 72 m; n=10 trials.

REVIEWER'S CONCLUSIONS

Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD.

Authors+Show Affiliations

Centre de pneumologie, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, 2725 Chemin Ste-Foy, Ste-Foy, Québec, Canada, G1V 4G5. Yves.Lacasse@med.ulaval.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

12137716

Citation

Lacasse, Y, et al. "Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease." The Cochrane Database of Systematic Reviews, 2002, p. CD003793.
Lacasse Y, Brosseau L, Milne S, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002.
Lacasse, Y., Brosseau, L., Milne, S., Martin, S., Wong, E., Guyatt, G. H., & Goldstein, R. S. (2002). Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews, (3), CD003793.
Lacasse Y, et al. Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease. Cochrane Database Syst Rev. 2002;(3)CD003793. PubMed PMID: 12137716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary rehabilitation for chronic obstructive pulmonary disease. AU - Lacasse,Y, AU - Brosseau,L, AU - Milne,S, AU - Martin,S, AU - Wong,E, AU - Guyatt,G H, AU - Goldstein,R S, PY - 2002/7/26/pubmed PY - 2002/9/25/medline PY - 2002/7/26/entrez SP - CD003793 EP - CD003793 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115-1119. OBJECTIVES: To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD. SEARCH STRATEGY: The 14 randomized controlled trials (RCTs) included in the original meta-analysis were included. Additional RCTs were identified from the Cochrane Airways Group's registry of COPD RCTs using the strategy: [exp, lung diseases, obstructive] and [exp, rehabilitation or exp, exercise therapy] and [research design or longitudinal studies or evaluation study or randomized controlled trial]. Abstracts presented at American Thoracic Society 1980-2000, American College of Chest Physicians 1980-2000 and European Respiratory Society 1987-2000 were also searched. SELECTION CRITERIA: RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least 4 weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation. DATA COLLECTION AND ANALYSIS: Weighted mean differences (WMD) were calculated using a random-effects model. Missing data from the primary study reports were requested from the authors. MAIN RESULTS: 23 RCTs met the inclusion criteria. Statistically significant improvements were found for all the outcomes. In three important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units using this instrument. For example Dyspnoea score: WMD 0.98 units, 95% Confidence Interval (95% CI) 0.74 - 1.22 units; n=9 trials. For FEC and MEC, the effect was small and a little below the threshold of clinical significance for the 6- minute walking distance: WMD 49 m, 95% CI: 26 - 72 m; n=10 trials. REVIEWER'S CONCLUSIONS: Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12137716/Pulmonary_rehabilitation_for_chronic_obstructive_pulmonary_disease_ L2 - https://doi.org/10.1002/14651858.CD003793 DB - PRIME DP - Unbound Medicine ER -