School of Public Health, Health Technology and Policy Unit, 3-021 Research Transition Facility, University of Alberta, Edmonton, Alberta, T6G 2V2, Canada.
Alberta Health Services, Edmonton, Alberta, Canada.
BMC Health Serv Res. 2022 Apr 26;22(1):557. doi: 10.1186/s12913-022-07779-9.
Although pulmonary rehabilitation (PR) is considered a key component in managing chronic obstructive pulmonary disease (COPD) patients, uptake remains suboptimal. This systematic review aimed to determine the effectiveness of home-based PR (HBPR) programs for COPD patients.
A systematic review of scholarly literature published within the last 10 years from the conception of this project was conducted using internationally recognized guidelines. Search strategies were applied to electronic databases and clinical trial registries through March 2020 and updated in November 2021 to identify studies comparing HBPR with 'usual care' or outpatient pulmonary rehabilitation (OPR). To critically appraise randomized studies, the Cochrane Collaboration risk of bias tool (ROB) was used. The quality of non-randomized studies was evaluated using the ACROBAT-NRSI tool. The quality of evidence relating to key outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) on health-related quality of life (HRQoL), exacerbation frequencies, COPD-related hospital admissions, and program adherence. Three independent reviewers assessed methodologic quality and reviewed the studies.
Twelve randomized controlled trials (RCTs) and 2 comparative observational studies were included. While considerable evidence relating to the effectiveness of HBPR programs for COPD patients exist, overall quality is low. There were no differences between HBPR and OPR in terms of safety, HRQoL, functional exercise capacity and health care resource utilization. Compared to usual care, functional exercise capacity seemed to significantly improve after HBPR. While patient compliance with HBPR is good, two factors appeared to increase the 'risk' of non-compliance: expectations of patients to 1) complete daily diaries/activity logs and 2) engage in solely unsupervised exercise sessions.
The overall quality for most outcomes was low to very low; however, HBPR seems to offer comparable short-term benefits to OPR.
虽然肺康复（PR）被认为是管理慢性阻塞性肺疾病（COPD）患者的关键组成部分，但采用率仍不理想。本系统评价旨在确定针对 COPD 患者的家庭为基础的 PR（HBPR）计划的有效性。
使用国际公认的指南，对过去 10 年内从项目构思开始发表的学术文献进行系统评价。检索策略应用于电子数据库和临床试验登记处，检索时间截至 2020 年 3 月，并于 2021 年 11 月更新，以比较 HBPR 与“常规护理”或门诊肺康复（OPR）的研究。为了批判性地评价随机研究，使用 Cochrane 协作风险偏倚工具（ROB）。使用 ACROBAT-NRSI 工具评估非随机研究的质量。使用健康相关生活质量（HRQoL）、恶化频率、COPD 相关住院和计划依从性评估与关键结局相关的证据质量，使用推荐评估、制定与评估（GRADE）工具。三位独立评审员评估方法学质量并审查研究。
纳入了 12 项随机对照试验（RCT）和 2 项比较观察性研究。尽管有大量关于 COPD 患者 HBPR 计划有效性的证据，但总体质量较低。HBPR 与 OPR 在安全性、HRQoL、功能运动能力和卫生保健资源利用方面无差异。与常规护理相比，HBPR 后功能运动能力似乎显著改善。尽管 HBPR 的患者依从性良好，但有两个因素似乎增加了不依从的“风险”：患者期望 1）完成每日日记/活动记录，2）仅进行非监督的运动。
大多数结局的总体质量为低至极低；然而，HBPR 似乎提供了与 OPR 相当的短期益处。
