Effect of Pulmonary Rehabilitation on Postoperative Clinical Status in Patients with Lung Cancer and Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Pulmonary rehabilitation (PR) has a curative effect in patients undergoing pneumonectomy for lung cancer. Nevertheless, the contribution of PR to the clinical status of patients with chronic obstructive pulmonary disease (COPD) undergoing lung resection has not been adequately elucidated. The aim of this systematic review of randomized and nonrandomized controlled trials was to appraise the impact of PR compared to conventional treatment based on postoperative clinical status in patients with lung cancer and COPD. Literature in English from PubMed, Cochrane Library, Science Citation Index, and Embase databases and in Chinese from the Chinese National Knowledge Infrastructure and the WANFANG Database was retrieved from inception to November 2021, employing the keywords “Pulmonary Neoplasms,” “Chronic Obstructive Pulmonary Diseases,” “Physical Therapy Modalities,” and “pulmonary rehabilitation.” Only studies that reported PR results were included. This review was registered in the International Prospective Register of Systematic Reviews (number: CRD42021224343). A total of nine controlled trials with 651 patients were included. Postoperative pulmonary complications (PPCs) were the primary outcome measure. PR decreased the risk of complications after surgery compared to regular treatment (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.12–0.37, P < 0.01 ). PR reduced the risk of pneumonia after surgery compared to regular treatment (OR 0.36, 95% CI 0.15–0.86, P = 0.02 ). There was a significant difference in the postoperative length of stay (mean difference −2.13 days, 95% CI −2.65 to −1.61 days, P < 0.05 ). PR was an effective intervention that decreased PPCs in patients suffering from lung cancer and COPD. However, due to the limitations of the available data, the results should be interpreted with caution.

Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis

“…The findings of this study are in agreement with the previous reviews that have also demonstrated a significant impact of pulmonary rehabilitation nursing intervention on reducing postoperative pulmonary complication. 33 , 34 …”

Effectiveness of precise and quantitative rapid pulmonary rehabilitation nursing program for elderly patients with lung cancer during the perioperative period: A randomized controlled trial

“…This proves that our nursing pulmonary rehabilitation program has a wholesome effect on the patients' postoperative outcomes positively affecting their physical, social and mental health. However, previous studies found no significant improvement in the quality of life postoperatively following a pulmonary rehabilitation program [17][18][19][20][21] intensity being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from higher levels of intensity.…”

“…17 Indeed, trials exploring the effectiveness of such a program amongst patients with lung cancer reported such findings. [18][19][20][21] We cannot make conclusions about the quality of life on the basis of our results given the differences in the tools, intervention designs, and/or extent of the surgical operations in the different relevant studies. We used the EQ-5D, which is a worldwide standard tool for measuring quality of life; and, the questionnaire has been validated for use and a valuation set for our country is available.…”

Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: a randomised controlled trial

“…After enrolment, patients in all groups participated in a multidisciplinary conventional inpatient rehabilitation program on the day of admission and day before surgery, and the program was standardised using evidence from systematic reviews and mainly included exercise, education, nutritional, respiratory physiotherapy, and psychological counselling [ 27 , 28 ]. All participants were provided information and instructions regarding perioperative management.…”