A meta-analysis on the structure of pulmonary rehabilitation maintenance programmes on COPD patients’ functional capacity

Abstract

Pulmonary rehabilitation (PR) improves functional capacity, health-related quality of life (HRQoL) in COPD patients, and maintenance programmes are relevant in preserving those improvements. However, little is known about the structure of maintenance programmes after PR. We performed a systematic review and meta-analysis of experimental and quasi-experimental studies evaluating individuals with COPD admitted to a maintenance PR programme, delivered after an initial PR programme. We reported functional capacity evaluation (6-minute-walking-test), HRQoL, dyspnoea and symptom control. Searches were performed on the 11th April 2021 using MEDLINE, Embase, EBSCO, CINAHL, Web of Science and Cochrane Library. We extracted summary-level data from trial publications and used a random-effects model, predicting that severe heterogeneity was detected. The protocol was registered in PROSPERO (CRD42021247724). Fifteen studies were included in the meta-analysis, with 1151 participants. Maintenance programmes were associated with a pooled mean increase of 27.08 meters in 6mWT (CI: 10.39 to 43.77; I2 = 93%; p < 0.0001), being better in supervised, long (>12 month) home-based programmes; and having a potential MD of -4.20 pts in SGRQ (CI: -4.49 to -3.91; I2 = 0%; p = 0.74). Regarding dyspnoea and exacerbations, we found a nonsignificant trend for improvement after maintenance PR programmes. Severe COPD patients showed smaller improvements in programmes up to a year. Overall, the strength of the underlying evidence was moderate. Despite limitations of risk of bias and heterogeneity, our results support that home-based, supervised, long-term maintenance PR programmes may significantly improve functional capacity in COPD patients and HRQoL.

Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis

“…Additionally, VR has been found to have a positive effect in mood and emotional state [ 16 ]. COPD patients need to follow an active lifestyle and exercise regularly in order to maintain the benefits of traditional pulmonary rehabilitation [ 17 ]. While this is not often possible due to various reasons, technology could assist.…”

Association of Fetal Lung Development Disorders with Adult Diseases: A Comprehensive Review

“…Personalized care is a cornerstone in the effective management of individuals with a history of fetal lung development disorders. Healthcare plans, uniquely tailored to accommodate an individual's medical history, current respiratory function, and potential risk factors, can bolster disease prevention and improve treatment outcomes [215,219,220]. The utility of personalized care is increasingly recognized in modern medicine, with numerous studies emphasizing its potential to revolutionize the management of chronic diseases like asthma and COPD [221][222][223][224].…”

Pulmonary rehabilitation and physical interventions

“…In addition, a trajectory for follow-up needs to be established when the initial programme comes to an end. When patients can continue some form of continued exercise training as part of their disease management, outcomes are considerably better [ 16 ]. Such a maintenance programme completes the pulmonary rehabilitation process.…”

“…After the core programme, it is important that a maintenance programme is set up in order to maintain its benefits and result in a sustained improvement in utilisation of healthcare resources [ 108 ]. Such programmes can be organised in the community or in primary care [ 16 ].…”