Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Objective To evaluate the efficacy and safety of early pulmonary rehabilitation (PR) (ie, <3 days of hospitalization) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Embase, Web of Science, PubMed and Cochrane Library were searched from their inception to 1 April 2021. Randomized controlled trials were included if they observed the efficacy of early PR in AECOPD patients. Study selection, data extraction, risk of bias and quality of evidence were assessed by two researchers independently. Assessment of the risk of bias and eidence quality were evaluated by the Cochrane Collaboration’s tool and Grading of Recommendations, Assessment, Development and Evaluation system, respectively. Results Fourteen trials (829 participants) were identified. Significant improvement was found in the 6-minute walk distance (6MWD; mean difference (MD): 69.64; 95% CI: 40.26 to 99.01; Z = 4.65, P < 0.0001, low quality). In the subgroup analysis, the exercise-training group showed marked improvement (MD: 96.14; 95% CI: 20.24 to 172.04; Z = 2.48, P = 0.001). The Saint George’s Respiratory Questionnaire (SGRQ) total score was low (MD: −12.77; 95% CI: −16.03 to −9.50; Z = 7.67, P < 0.0001, moderate quality). Significant effects were not found for the duration of hospital stay, quadriceps muscle strength or five times sit to stand test. Only one serious adverse event was reported in experimental group, which was not associated with early PR. Conclusion PR initiated <3 days of hospitalization may increase exercise capacity and improve quality of life, but the results should be interpreted prudently and dialectically, and the role of early PR in AECOPD needs further exploration.

Effectiveness of neuromuscular electrical stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

“…The use of NMES may be effective in preventing muscle atrophy and weakness, particularly in patients with declining activity levels. A review of PR that included a variety of programs did not conclude that limb muscle strength improved (Zhang et al., 2021). Therefore, NMES is considered more useful for maintaining and improving limb muscle strength; however, the installation of NMES, which requires devices, requires an examination of cost and demand.…”

Combined Effect of Early Nutrition Therapy and Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Prospective Randomized Controlled Trial

“…Zhang et al conducted a meta-analysis of 14 randomized controlled trials on early RPs in patients with COPD exacerbations [ 19 ]. Most patients were in their 60s, and only three studies included participants older than 70 years in both groups; therefore, the participants in our study were considered relatively old.…”

Exercise rehabilitation in pediatric asthma: A systematic review and network meta‐analysis

“…As a comprehensive intervention measure, PR shows beneficial advantages for relieving clinical symptoms, increasing exercise endurance, and improving quality of life. 36 PR is considered the first-line nondrug therapy for chronic respiratory diseases and proven effective in childhood asthma. [37][38][39] Exercise training, the cornerstone of PR, comes in a variety of forms, and it is yet unclear which may It has been reported that exercise can improve cardiorespiratory fitness and muscle strength, to relieve or control asthma.…”

“…As a comprehensive intervention measure, PR shows beneficial advantages for relieving clinical symptoms, increasing exercise endurance, and improving quality of life 36 . PR is considered the first‐line nondrug therapy for chronic respiratory diseases and proven effective in childhood asthma 37–39 .…”