Langer D, Hendriks Ejm, Burtin C, Probst V, van der Schans Cp, Paterson Wj, Verhoef-de Wijk McE, Straver Rvm, Klaassen M, Troosters T, Decramer M, Ninane V, Delguste P, Muris J, Gosselink R
Departments of Pneumology and Respiratory Rehabilitation, University Hospital Leuven and Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Clin Rehabil. 2009 May;23(5):445-62. doi: 10.1177/0269215509103507. Epub 2009 Apr 23.
Update of a clinical practice guideline for the physiotherapy management of patients with chronic obstructive pulmonary disease supporting the clinical decision-making process.
A systematic computerized literature search was performed on different modalities for improving physical exercise capacity, reducing exertional dyspnoea, improving airway clearance and encouraging changes in physical activity behaviour. Methodological quality was scored with the PEDro Scale. Scientific conclusions were graded according to the criteria of the; Dutch Evidence Based Guideline Development Platform'. These, together with practical considerations, were used to formulate recommendations for clinical practice.
A total of 103 studies were included in the systematic review, consisting of five meta-analyses of randomized controlled trials, 84 randomized controlled trials and 14 uncontrolled studies. Twenty scientific conclusions supported six recommendations on physical exercise training. Nineteen scientific conclusions supported eight recommendations on interventions for reducing dyspnoea. Five scientific conclusions supported seven recommendations concerning treatment modalities to improve mucus clearance, and two scientific conclusions supported two recommendations on strategies for encouraging permanent changes in physical activity behaviour.
Strong recommendations support the use of physical exercise training to improve health-related quality of life and functional exercise capacity. Future research should investigate whether additional interventions for reducing exertional dyspnoea have a place as adjuncts to physical exercise training in selected patients. In addition, treatment of impaired mucus clearance, especially during acute exacerbations, requires further research. With the advance of new technologies for objective measurements of physical activities in daily life more research is needed concerning interventions to initiate and maintain physical activity behaviour change during and after supervised physical exercise training programmes.
更新慢性阻塞性肺疾病患者物理治疗管理的临床实践指南，以支持临床决策过程。
对改善身体运动能力、减轻运动性呼吸困难、改善气道清除以及促进身体活动行为改变的不同方式进行了系统的计算机文献检索。采用PEDro量表对方法学质量进行评分。科学结论根据荷兰循证指南制定平台的标准进行分级。这些结论与实际考虑因素一起被用于制定临床实践建议。
系统评价共纳入103项研究，包括五项随机对照试验的荟萃分析、84项随机对照试验和14项非对照研究。20条科学结论支持了关于体育锻炼训练的六条建议。19条科学结论支持了关于减轻呼吸困难干预措施的八条建议。五条科学结论支持了关于改善黏液清除治疗方式的七条建议，两条科学结论支持了关于鼓励身体活动行为永久改变策略的两条建议。
强有力的建议支持使用体育锻炼训练来改善与健康相关的生活质量和功能运动能力。未来的研究应调查在特定患者中，额外的减轻运动性呼吸困难的干预措施作为体育锻炼训练辅助手段是否有一席之地。此外，黏液清除受损的治疗，尤其是在急性加重期，需要进一步研究。随着用于客观测量日常生活中身体活动的新技术的发展，在监督性体育锻炼训练计划期间及之后，关于启动和维持身体活动行为改变的干预措施还需要更多研究。
