Background
In low-income countries (LIC) and low-middle-income countries (LMIC), the burden of chronic obstructive pulmonary disease (COPD) has increased due to the lack of prevention and the presence of barriers to enter rehabilitation programs. The aim of this systematic review is to analyze the evidence on pulmonary rehabilitation (PR) in LIC and LMIC.
Methods
A systematic literature review was conducted. Four electronic databases were searched for qualitative and quantitative studies that documented the presence of PR in LIC and LMIC. We report our findings following the Prisma guidelines. In addition, grey literature was also searched. Articles not in English, presenting a point of view and/or not treating an adult population (< 18 years old) were excluded from the review. Data were extracted by one reviewer and synthesized in the form of tables. Tables present individual characteristics of the PR reported within countries, including country of origin, study design, population attending, intervention (kind of program setting), frequency and duration of a program established (if available), with health outcomes. The PICO framework was used for every country with reported PR to assess population, intervention, comparison and outcomes found. This systematic review is registered on Prospero: CRD42020141655.
Results
In total, 47 publications were included in the review. In LIC, PR for HIV-infected patients was most frequently reported, while in LMIC, PR for COPD patients was most frequent. Duration and frequency of treatments reported were also different in LIC and LMIC. Health outcomes on cardiopulmonary function were established in all publications. Results found that the implementation of PR in LMIC is ongoing. The most important barriers to access are the lack of funds and know-how among professional healthcare givers.
Conclusion
Findings suggest that the literature on PR is scarce in LIC and LMIC. Structured or non-structured rehabilitation programs for patients suffering from COPD, HIV and Tuberculosis, are infrequently available. Strategic policy initiatives to diminish barriers and challenges are needed to implement more PR programs in LIC and LMIC.