Department of Physiotherapy, Monash University, Melbourne, VIC; Department of Physiotherapy, Monash Health, Melbourne, VIC.
Department of Physiotherapy, Monash University, Melbourne, VIC.
Chest. 2019 Jul;156(1):80-91. doi: 10.1016/j.chest.2019.04.009. Epub 2019 Apr 26.
Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with COPD; however, its effect on anxiety and depression symptoms is less clear. Existing data are difficult to apply to clinical PR because of diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD.
A systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomized controlled trials comparing PR (≥ 4 weeks' duration) with usual care. Four electronic databases were searched to February 2018 using terms related to COPD, PR, anxiety, and depression. Data were extracted by two assessors using standardized templates. Study quality was appraised via the PEDro scale, and evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation. Data were analyzed in RevMan 5.3, with pooled effect estimates reported as standardized mean differences (SMDs). The effect of the program duration (≤ 8 vs > 8 weeks) was explored via subgroup analysis.
Eleven studies comprising 734 participants (median PEDro score, 4/10) were included. Compared with usual care, PR conferred significant benefits of a moderate magnitude for anxiety symptoms (SMD, -0.53; 95% CI, -0.82 to -0.23) and large magnitude for depression symptoms (SMD, -0.70; 95% CI, -0.87 to -0.53). The certainty of evidence for each outcome was moderate. Effects were not moderated by program duration.
PR confers significant, clinically relevant benefits on anxiety and depression symptoms. Because further studies involving no treatment control groups are not indicated, these robust estimates of treatment effects are likely to endure.
肺康复（PR）可改善 COPD 患者的运动能力和生活质量；然而，其对焦虑和抑郁症状的影响尚不清楚。由于干预措施和对照因素的多样性，现有数据难以应用于临床 PR。本综述评估了 PR 对 COPD 患者焦虑和抑郁症状的疗效。
根据系统评价和荟萃分析的首选报告项目（PROSPERO CRD42018094172）的指南，对比较 PR（≥ 4 周）与常规护理的随机对照试验进行了系统评价和荟萃分析。使用与 COPD、PR、焦虑和抑郁相关的术语，在四个电子数据库中搜索到 2018 年 2 月的数据。两名评估员使用标准化模板提取数据。通过 PEDro 量表评估研究质量，并根据推荐评估、制定与评价分级系统对证据进行评级。使用 RevMan 5.3 进行数据分析，汇总效应估计值以标准化均数差（SMD）表示。通过亚组分析探讨了方案持续时间（≤ 8 周与> 8 周）的影响。
纳入了 11 项研究，共 734 名参与者（PEDro 评分中位数为 4/10）。与常规护理相比，PR 对焦虑症状有显著的中等程度改善（SMD，-0.53；95% CI，-0.82 至-0.23），对抑郁症状有显著的较大程度改善（SMD，-0.70；95% CI，-0.87 至-0.53）。每个结局的证据确定性为中等。方案持续时间未对效果产生影响。
PR 对焦虑和抑郁症状有显著的、有临床意义的改善。由于没有治疗对照组的进一步研究不被推荐，这些治疗效果的可靠估计可能会持续存在。
