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

Authors Rugbjerg M, Iepsen UW, Jørgensen K, Lange P

Received 3 December 2014

Accepted for publication 23 January 2015

Published 17 April 2015 Volume 2015:10(1) Pages 791—801


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Mette Rugbjerg,1 Ulrik Winning Iepsen,1 Karsten Juhl Jørgensen,2 Peter Lange1,3,4

1The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 2The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark; 3Department of Respiratory Medicine, University Hospital Hvidovre, Copenhagen, Denmark; 4Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark

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.

Keywords: pulmonary disease, COPD, COPD with mild symptoms, physical activity, pulmonary rehabilitation, health-related quality of life

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