Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh.
NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
NPJ Prim Care Respir Med. 2020 Nov 19;30(1):52. doi: 10.1038/s41533-020-00210-y.
Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
肺康复（PR）是一项指南推荐的多方面干预措施，可改善慢性呼吸系统疾病（CRD）患者的身体和心理健康，尽管大多数证据来自高资源环境中的试验。在低收入和中等收入国家，PR 服务提供不足。我们旨在审查低资源环境中 PR 的有效性、组成部分和交付模式。根据 Cochrane 方法，我们系统地检索了（1990 年至 2018 年 10 月；预发布更新 2020 年 3 月）MEDLINE、EMBASE、CABI、AMED、PUBMED 和 CENTRAL，以寻找低资源环境中成人 CRD（包括但不限于慢性阻塞性肺疾病）的 PR 与常规护理的对照临床试验。经过重复选择，我们提取了关于运动耐量、健康相关生活质量（HRQoL）、呼吸困难、包含的组成部分和交付模式的数据。我们使用 Cochrane 风险偏倚（RoB）评估研究质量，并进行了叙述性数据综合。从 8912 次命中中，我们纳入了 13 项研究：11 项研究的 RoB 较高；2 项研究的 RoB 为中度。PR 改善了 10 项研究中的功能运动能力，12 项研究中的 HRQoL，9 项研究中的呼吸困难。两项中度 RoB 研究之一显示无益处。所有计划都包括运动训练；大多数计划提供教育、胸部物理疗法和呼吸练习。低成本的服务，适应当地环境，使用有限的设备，通常结合门诊/中心交付与家庭/社区为基础的服务。多组分 PR 计划可以在低资源环境中实施，采用多种交付模式。需要进行高质量的试验来证实这些高/中度 RoB 研究的阳性发现。
