Systematic review (protocol) of clinical effectiveness and models of care of low-resource pulmonary rehabilitation

Abstract

More than half of the people with chronic respiratory diseases (CRDs) live in low- and middle-income countries (LMICs). The increasing disability, reduced productivity, associated anxiety and depression from CRDs result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) is a guideline-recommended multidisciplinary and multifaceted intervention that improves the physical and psychological condition of people with CRD. However, PR services are underprovided and uptake is poor in LMICs, especially in low-resourced setting. We aim to systematically assess the effectiveness, applicable components and mode of delivery of PR. We will search MEDLINE, EMBASE, CABI, AMED and CENTRAL from January 1990 using a PICOS search strategy (Population: adults with CRD (including chronic obstructive pulmonary disease, post-tuberculosis, remodelled asthma); Intervention: PR; Comparator: usual care; Outcomes: functional exercise capacity and Health-Related Quality-of-Life; Setting: low-resource settings). Two reviewers will independently screen titles/abstracts and full texts for eligibility and extract data from included papers. We will use the Cochrane Risk-of-Bias tool, rating the quality of evidence using GRADE. We will use narrative synthesis to answer our three objectives: What is the effectiveness of PR in low-resource settings? What components are used in effective studies? What models of service delivery are used? This systematic review will inform the potential impact and practical models of low-resource PR for the betterment of patients with CRDs to improve their substantial health-care burden and address poor quality of life.

Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings

“…Table 4. In summary, we undertook a duplicate selection process using rules for operationalising the inclusion/exclusion criteria (see protocol for details 74 . Disagreements were resolved by discussion, involving H.P.…”

Engaging with stakeholders in a research programme to promote implementation of pulmonary rehabilitation in Bangladesh: Challenges and opportunities

“…However, typically there are no structured, evidence-based pulmonary rehabilitation (PR) facilities available in LMICs, especially in rural communities and sometimes services are underprovided even in high-income countries [ 11 ]. Building on a systematic review of the clinical effectiveness, components and delivery of pulmonary rehabilitation services in low-resource settings [ 12 ], and to complement on-going feasibility work, we planned a programme of stakeholder engagement in Bangladesh. A number of stakeholder engagement events were held with the aim of raising awareness of the benefits of pulmonary rehabilitation, and to understand the views of patients, public health officials, policymakers, politicians, religious leaders, and other stakeholders about the initiative, and to explore how they could influence adoption of the findings of our research.…”

ERS International Congress, Madrid, 2019: highlights from the Allied Respiratory Professionals' Assembly

“…Functional and submaximal constant work rate tests (CWRTs) have been extensively used to assess cardiorespiratory and muscular endurance in people with COPD [29,30] The increasing demand to make exercise and pulmonary rehabilitation interventions accessible for different populations and settings [34] enforces a need for more simple, quick and universally applicable tests. OLIVEIRA et al [35] explored the physiological responses of the 1-min sit-to-stand (STS) test and the 6-min walk test (6MWT), aiming to establish whether these tests could be used interchangeably in patients with COPD and interstitial lung diseases [36].…”