Effectiveness of Home-Based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

Abstract

Home-based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD-associated respiratory symptoms and improving HRQoL and exercise capacity. Rigorously designed, large-scale RCTs are still needed to identify an optimal standard home-based pulmonary rehabilitation program.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Statistical heterogeneity of treatment effect between studies was assessed using Cochran's Q test and the inconsistency test (I 2 ), in which values below 40% do not pose a problem, values between 30% and 60% mean moderate heterogeneity, values between 50% and 90% mean substantial heterogeneity, and values between 75% and 100% mean considerable heterogeneity 23 . Heterogeneity, when found, was evaluated by the researchers, and the possible causes were explored through subgroup analyses.…”

“…The various meta-analyses focused on outcomes with high clinical significance, extending the findings of systematic reviews on the topic with data up to 2012 23,24,25 . No relevant evidence of heterogeneities was observed in at least three of the meta-analyses, while we explored the other heterogeneities that were detected.…”

“…While this study was in progress, a systematic review was published with a meta-analysis of 18 studies comparing HCPR and control groups, published up to 2012 23 . The authors identified only 814 studies in databases, without using a sensitive search for RCTs and including studies that did not meet our inclusion criteria (since they did not involve exercises, were not RCTs, or did not meet our criteria for the minimum intervention time).…”

“…Other RCTs that compared standard OPR to home or community-based PR show similar results and greater effectiveness of HCPR for some outcomes such as exercise capacity and sensation of dyspnea 20,21,22 . Some systematic reviews 23,24,25 compare OPR to controls (no exercise), but none compare OPR and HCPR. Those systematic reviews showed that HCPR improved functional capacity and quality of life and reduced dyspnea sensation, but they used less comprehensive search strategies.…”

The Efficacy of Supervised Home-based Pulmonary Rehabilitation In Patients With Chronic Respiratory Disorders

“…In a meta-analysis published in 2014, 18 studies that involved cases with a diagnosis of COPD to whom supervised home-based/ unsupervised PR programs were applied and cases with a diagnosis of COPD who did not receive PR were examined. Although there were gains in the perception of dyspnea [Borg, basal dyspnea index (BDI)], quality of life (CRDQ, SGRQ), exercise capacity (6 min walk test), and respiratory functions (FEV 1 /FVC) in the group receiving PR, there was no significant difference between the two groups in admission to hospital, mortality, or maximum workload (14).…”