Significance of Pulmonary Rehabilitation in Improving Quality of Life for Subjects With COPD

Abstract

BACKGROUND: Increasingly, studies have shown that application of pulmonary rehabilitation (PR) may improve the quality of life (QOL) of patients with COPD. However, some studies remain controversial and were limited to small number of participants. We designed a systematic review and meta-analysis to evaluate the efficacy of PR in improving the QOL for subjects with COPD. METHODS: We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to March 29, 2018, to identify relevant randomized controlled trials that analyzed and evaluated the efficacy of PR in subjects with COPD. Participants were randomly assigned to receive PR (intervention group) or usual care (control group). We used Chronic Respiratory Questionnaire scores, which include 4 important domains (ie, Fatigue, Emotion, Mastery, and Dyspnea) as the evaluating indicators of QOL. Mean differences with 95% CI were estimated to compare the outcomes of the groups. We also performed subgroup analysis for the pooled results of PR effects in subjects with COPD. In addition, a sensitivity analysis was performed to examine the stability of the combined results. Two reviewers assessed trial quality and extracted data independently. RESULTS: Seventeen randomized controlled trials (N ‫؍‬ 1,649 participants) were identified for the present analysis. In comparing PR groups with usual care groups, we identified significant effects in QOL improvement as measured by the Chronic Respiratory Questionnaire scores for fatigue (Mean difference 0.60, 95% CI 0.36 -0.84, P < .001), mastery (Mean difference 0.59, 95% CI 0.32-0.85, P < .001), and dyspnea (Mean difference 0.70, 95% CI 0.46 -0.94, P < .001), but no clinically important improvement was found in emotion (Mean difference 0.45, 95% CI 0.23-0.67, P < .001) according to the minimal clinically important difference that we defined as mean difference > 0.5 units. CONCLUSION: PR may constitute an important component of COPD management and may be beneficial in improving QOL. Key words: pulmonary rehabilitation; COPD; quality of life. [Respir Care 2019;64(1):99 -107.

Technological advances and digital solutions to improve quality of life in older adults with chronic obstructive pulmonary disease: a systematic review

“…In contrast, intriguing results were reported in terms of the number of respiratory events and hospitalization rate, with two studies suggesting positive effects of tele-monitoring systems on these crucial outcomes [ 38 , 39 ]. Thus, these results are particularly important due to the higher rate of pulmonary complications in frail older patients that might need a comprehensive approach, including digital innovation, with positive implications in terms of both clinical outcomes and sanitary cost reduction [ 41 – 45 ]. In addition, it should be noted that positive effects on sanitary costs have been previously reported, underlining that the clinical implementation of a tele-monitoring system in routine clinical settings might be a suitable strategy to enhance the long-term health care of older patients affected by COPD.…”

Pulmonary Rehabilitation in the Management of Chronic Obstructive Pulmonary Disease among Asian Indians- Current Status and Moving Forward

“…Early initiation of PR can potentially minimize the effect of acute exacerbations on the skeletal muscle and prevent the deterioration of skeletal muscle to a significant extent [23], thus appearing to be an effective strategy to change the course of the disease [24]. Several other studies have demonstrated significant improvement in muscle function and quality of life [25][26][27][28][29][30], psychosocial wellbeing [31], reduction in mortality, and rate of hospitalization [32] following successful completion of PR. The benefits of PR can be further maximized by introducing supplemental nutrition [33,34].…”

Closing the Gap between Inpatient and Outpatient Settings: Integrating Pulmonary Rehabilitation and Technological Advances in the Comprehensive Management of Frail Patients

“…Although chronic diseases and frailty are often treated as separated conditions, they share different multilevel interactions, and several disabling conditions play a pivotal role in frailty onset [ 11 ]. Due to the higher rate of pulmonary complications, frail patients might require an integrated rehabilitation approach including PR with relevant implications in terms of both physical wellbeing and quality of life improvement [ 12 , 13 , 14 , 15 , 16 ]. However, to the best of our knowledge, no previous study emphasized the role of PR in these patients.…”