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Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses.

Abstract

PURPOSE

Most guidelines recommend pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD) and modified Medical Research Council dyspnea scale (mMRC) levels ≥2, but the effectiveness of PR in patients with less advanced disease is not well established. Our aim was to investigate the effects of PR in patients with COPD and mMRC ≤1.

METHODS

The methodology was developed as a part of evidence-based guideline development and is in accordance with the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. We identified randomized controlled trials (RCTs) through a systematic, multidatabase literature search and selected RCTs comparing the effects of PR with usual care in patients with COPD and mMRC ≤1. Predefined critical outcomes were health-related quality of life (HRQoL), adverse effects and mortality, while walking distance, maximal exercise capacity, muscle strength, and dropouts were important outcomes. Two authors independently extracted data, assessed trial eligibility and risk of bias, and graded the evidence. Meta-analyses were performed when deemed feasible.

RESULTS

Four RCTs (489 participants) were included. On the basis of moderate-quality evidence, we found a clinically and statistically significant improvement in short-term HRQoL of 4.2 units (95% confidence interval [CI]: [-4.51 to -3.89]) on St George's Respiratory Questionnaire, but not at the longest follow-up. We also found a statistically significant improvement of 25.71 m (95% CI: [15.76-35.65]) in the 6-minute walk test with PR; however, this improvement was not considered clinically relevant. No difference was found for mortality, and insufficient data prohibited meta-analysis for muscle strength and maximal exercise capacity. No adverse effects were reported.

CONCLUSION

We found a moderate quality of evidence suggesting a small, significant improvement in short-term HRQoL and a clinically nonsignificant improvement in walking distance following PR in patients with COPD and mild symptoms. This resulted in a weak recommendation of routine PR in these patients using the GRADE approach.

Authors+Show Affiliations

The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark ; Department of Respiratory Medicine, University Hospital Hvidovre, Copenhagen, Denmark ; Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

25945044

Citation

Rugbjerg, Mette, et al. "Effectiveness of Pulmonary Rehabilitation in COPD With Mild Symptoms: a Systematic Review With Meta-analyses." International Journal of Chronic Obstructive Pulmonary Disease, vol. 10, 2015, pp. 791-801.
Rugbjerg M, Iepsen UW, Jørgensen KJ, et al. Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses. Int J Chron Obstruct Pulmon Dis. 2015;10:791-801.
Rugbjerg, M., Iepsen, U. W., Jørgensen, K. J., & Lange, P. (2015). Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses. International Journal of Chronic Obstructive Pulmonary Disease, 10, pp. 791-801. doi:10.2147/COPD.S78607.
Rugbjerg M, et al. Effectiveness of Pulmonary Rehabilitation in COPD With Mild Symptoms: a Systematic Review With Meta-analyses. Int J Chron Obstruct Pulmon Dis. 2015;10:791-801. PubMed PMID: 25945044.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses. AU - Rugbjerg,Mette, AU - Iepsen,Ulrik Winning, AU - Jørgensen,Karsten Juhl, AU - Lange,Peter, Y1 - 2015/04/17/ PY - 2015/5/7/entrez PY - 2015/5/7/pubmed PY - 2016/2/5/medline KW - COPD KW - COPD with mild symptoms KW - health-related quality of life KW - physical activity KW - pulmonary disease KW - pulmonary rehabilitation SP - 791 EP - 801 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 10 N2 - PURPOSE: Most guidelines recommend pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD) and modified Medical Research Council dyspnea scale (mMRC) levels ≥2, but the effectiveness of PR in patients with less advanced disease is not well established. Our aim was to investigate the effects of PR in patients with COPD and mMRC ≤1. METHODS: The methodology was developed as a part of evidence-based guideline development and is in accordance with the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. We identified randomized controlled trials (RCTs) through a systematic, multidatabase literature search and selected RCTs comparing the effects of PR with usual care in patients with COPD and mMRC ≤1. Predefined critical outcomes were health-related quality of life (HRQoL), adverse effects and mortality, while walking distance, maximal exercise capacity, muscle strength, and dropouts were important outcomes. Two authors independently extracted data, assessed trial eligibility and risk of bias, and graded the evidence. Meta-analyses were performed when deemed feasible. RESULTS: Four RCTs (489 participants) were included. On the basis of moderate-quality evidence, we found a clinically and statistically significant improvement in short-term HRQoL of 4.2 units (95% confidence interval [CI]: [-4.51 to -3.89]) on St George's Respiratory Questionnaire, but not at the longest follow-up. We also found a statistically significant improvement of 25.71 m (95% CI: [15.76-35.65]) in the 6-minute walk test with PR; however, this improvement was not considered clinically relevant. No difference was found for mortality, and insufficient data prohibited meta-analysis for muscle strength and maximal exercise capacity. No adverse effects were reported. CONCLUSION: We found a moderate quality of evidence suggesting a small, significant improvement in short-term HRQoL and a clinically nonsignificant improvement in walking distance following PR in patients with COPD and mild symptoms. This resulted in a weak recommendation of routine PR in these patients using the GRADE approach. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/25945044/Effectiveness_of_pulmonary_rehabilitation_in_COPD_with_mild_symptoms:_a_systematic_review_with_meta_analyses_ L2 - https://dx.doi.org/10.2147/COPD.S78607 DB - PRIME DP - Unbound Medicine ER -