Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases: a systematic review protocol

Abstract

IntroductionChronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care.Methods and analysisWe will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for ‘Chronic Respiratory Disease’ AND ‘Pulmonary Rehabilitation’ AND ‘Home-PR’, and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR?Ethics and disseminationResearch ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences.PROSPERO registration numberCRD42020220137.

Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis

“…We were open to including non-English language papers. We employed a rigorous methodology following a written protocol that has been published [ 36 ]. Although we searched for a wide range of chronic respiratory diseases, the included trials only recruited people with COPD, so the findings are not generalisable to people with other chronic respiratory diseases.…”

“…We followed Cochrane methodology [34], and used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [35] to report our review findings. The review is registered at www.crd.york.ac.uk/PROSPERO (CRD42020220137) and the protocol has been published [36].…”

“… CRD: chronic respiratory disease; COVID-19: coronavirus disease 2019; PR: pulmonary rehabilitation; PIAT: pulmonary impairment after tuberculosis; ILD: interstitial lung disease; CF: cystic fibrosis; ICU: intensive care unit; HRQoL: health-related quality of life; SGRQ: St George's Respiratory Questionnaire; CRQ: Chronic Respiratory Questionnaire; EQ-5D: EuroQol Five Dimension; 6MWT: 6-min walk test; ISWT: incremental shuttle walking test; ESWT: endurance shuttle walking test; mMRC: modified Medical Research Council dyspnoea scale; CCQ: Clinical COPD Questionnaire; HADS: Hospital Anxiety and Depression Scale; PHQ-9: Patient Health Questionnaire-9; STAI: State-Trait Anxiety Inventory; RCT: randomised controlled trial; CCT: clinical controlled trial. Reproduced from [ 36 ] with permission. …”

“…Our a priori subgroups were high-/low-income countries, chronic respiratory disease diagnosis, severity, intensity of intervention and arrangements for supervision of the home-PR programme [ 36 ]. We undertook a sensitivity analysis of our primary outcomes for the home-PR versus centre-PR comparison excluding studies at high risk of bias (there were too few studies for a sensitivity analysis of the home-PR versus usual care analysis).…”

Effects of exercise-based home pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: An overview of systematic review

“…However, absenteeism and loss of follow-up in pulmonary rehabilitation programs are widespread due to a lack of planning, travel and transportation challenges, and other health concerns [ 14 ]. The current COVID-19 pandemic has increased the number of patients with PR indications, and it has also raised the strain on PR services by increasing treatment obstacles due to cross-infection concerns [ 15 ].…”