de Oliveira Túlio Medina Dutra, Pereira Adriano Luiz, Costa Giovani Bernardo, de Souza Mendes Liliane P, de Almeida Leonardo Barbosa, Velloso Marcelo, Malaguti Carla
Department of Cardiorespiratory and Skeletal Muscle Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
Empresa Brasileira de Serviços Hospitalares/Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
Front Rehabil Sci. 2022 Mar 30;3:780736. doi: 10.3389/fresc.2022.780736. eCollection 2022.
This paper presents a rapid review of the literature for the components, benefits, barriers, and facilitators of pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) people in-home and community-based settings. seventy-six studies were included: 57 home-based pulmonary rehabilitation (HBPR) studies and 19 community-based pulmonary rehabilitation (CBPR) studies. The benefits of HBPR on exercise capacity and health-related quality of life were observed in one-group studies, studies comparing HBPR to usual care, and studies comparing to hospital-based pulmonary rehabilitation, although the benefits were less pronounced in the latter. HBPR reduced hospital admissions compared to usual care and was more cost-effective than hospital pulmonary rehabilitation. Most HBPRs were designed with low-density or customized equipment, are minimally supervised, and have a low intensity of training. Although the HBPR has flexibility and no travel burden, participants with severe disease, physical frailty, and complex comorbidities had barriers to complying with HBPR. The telerehabilitation program, a facilitator for HBPR, is feasible and safe. CBPR was offered in-person supervision, despite being limited to physical therapists in most studies. Benefits in exercise capacity were shown in almost all studies, but the improvement in health-related quality of life was controversial. Patients reported the benefits that facilities where they attended the CBPR including social support and the presence of an instructor. They also reported barriers, such as poor physical condition, transport difficulties, and family commitments. Despite the minimal infrastructure offered, HBPR and CBPR are feasible, safe, and provide clinical benefits to patients with COPD. Home and community settings are excellent opportunities to expand the offer of pulmonary rehabilitation programs, as long as they follow protocols that ensure quality and safety following current guidelines.
本文对慢性阻塞性肺疾病（COPD）患者在家庭和社区环境中进行肺康复的组成部分、益处、障碍及促进因素进行了快速文献综述。共纳入76项研究：57项家庭肺康复（HBPR）研究和19项社区肺康复（CBPR）研究。在单组研究、将HBPR与常规护理进行比较的研究以及与医院肺康复进行比较的研究中，均观察到HBPR对运动能力和健康相关生活质量的益处，尽管在后一种研究中益处不太明显。与常规护理相比，HBPR减少了住院次数，且比医院肺康复更具成本效益。大多数HBPR采用低密度或定制设备设计，监督最少，训练强度低。尽管HBPR具有灵活性且无出行负担，但重症、身体虚弱和合并复杂疾病的参与者在遵守HBPR方面存在障碍。远程康复计划作为HBPR的促进因素，是可行且安全的。CBPR提供现场监督，尽管在大多数研究中仅限于物理治疗师。几乎所有研究都显示了运动能力的益处，但健康相关生活质量的改善存在争议。患者报告了他们参加CBPR的场所带来的益处，包括社会支持和有指导人员。他们也报告了一些障碍，如身体状况差、交通困难和家庭事务。尽管提供的基础设施最少，但HBPR和CBPR是可行、安全的，并且能为COPD患者带来临床益处。只要遵循确保质量和安全的方案并符合现行指南，家庭和社区环境是扩大肺康复计划提供范围的绝佳机会。
