Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.
Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
Eur Respir Rev. 2020 Nov 18;29(158). doi: 10.1183/16000617.0039-2020. Print 2020 Dec 31.
This systematic review aimed to systematise the different designs used to deliver pulmonary rehabilitation during acute exacerbations of COPD (AECOPD) and explore which ones are the most effective. PubMed, Scopus, Web of Science, EBSCO and Cochrane were searched. Randomised controlled trials comparing pulmonary rehabilitation or at least one of its components with usual care or comparing different components of pulmonary rehabilitation were included. Network meta-analysis was conducted in MetaXL 5.3 using a generalised pairwise modelling framework. Pooled effects compared each treatment to usual care. 42 studies were included. Most studies were conducted in an inpatient setting (57%) and started the intervention 24-48 h after hospital admission (24%). Exercise training (71%), education and psychosocial support (57%) and breathing techniques (55%) were the most used components. Studies combining exercise with breathing techniques presented the larger effects on exercise capacity (weighted mean difference (WMD) -41.06, 95% CI -131.70-49.58) and health-related quality of life (WMD 16.07, 95% CI 10.29-21.84), and breathing techniques presented the larger effects on dyspnoea (WMD 1.90, 95% CI 0.53-3.27) and length of hospitalisation (effect size =0.15, 95% CI -0.28-0.57). A few minor adverse events were found.Pulmonary rehabilitation is a safe intervention during AECOPD. Exercise, breathing techniques, and education and psychosocial support seem to be the core components for implementing pulmonary rehabilitation during AECOPD. Studies may now focus on comparisons of optimal timings to start the intervention, total duration of the intervention, duration and frequency of sessions, and intensity for exercise prescription.
本系统评价旨在系统地总结在 COPD 急性加重期（AECOPD）期间实施肺康复的不同设计，并探讨哪些设计最有效。我们检索了 PubMed、Scopus、Web of Science、EBSCO 和 Cochrane。纳入了比较肺康复或其至少一个组成部分与常规护理或比较肺康复不同组成部分的随机对照试验。使用广义成对建模框架在 MetaXL 5.3 中进行网络荟萃分析。汇总效应将每种治疗方法与常规护理进行比较。共纳入 42 项研究。大多数研究在住院环境中进行（57%），并在入院后 24-48 小时开始干预（24%）。运动训练（71%）、教育和心理社会支持（57%）和呼吸技术（55%）是最常用的组成部分。将运动与呼吸技术相结合的研究在运动能力方面表现出更大的效果（加权均数差（WMD）-41.06，95%CI-131.70-49.58）和健康相关生活质量（WMD 16.07，95%CI 10.29-21.84），呼吸技术在呼吸困难方面表现出更大的效果（WMD 1.90，95%CI 0.53-3.27）和住院时间（效应大小=0.15，95%CI-0.28-0.57）。发现了一些轻微的不良事件。在 AECOPD 期间，肺康复是一种安全的干预措施。运动、呼吸技术以及教育和心理社会支持似乎是在 AECOPD 期间实施肺康复的核心组成部分。现在的研究可能集中在比较开始干预的最佳时机、干预的总持续时间、治疗的持续时间和频率以及运动处方的强度。
