Norwegian Institute of Public Health, Oslo, Norway; Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
Respir Med. 2023 Nov-Dec;219:107425. doi: 10.1016/j.rmed.2023.107425. Epub 2023 Oct 17.
This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach.
This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence).
Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence.
The study protocol was registered in Open Science Framework (https://osf.io/amgbz/).
本系统综述总结了肺康复对慢性阻塞性肺疾病急性加重（AECOPD）患者的疗效（益处和危害）的证据。
我们纳入了比较肺康复与主动干预或常规护理的随机对照试验，无论设置如何。2022 年 3 月，我们检索了 MEDLINE、Scopus、CENTRAL、CINAHL 和 Web of Sciences 以及试验注册库。记录筛选、数据提取和偏倚风险评估由两名评审员进行。我们使用 GRADE 方法评估证据的确定性。
本系统综述纳入了 18 项研究（n=1465），涉及混合环境（8 项研究）、住院环境（8 项研究）和门诊环境（2 项研究）的组合。这些研究存在较高的效能、检测和报告偏倚风险。与常规护理相比，肺康复可能改善 AECOPD 相关的住院再入院率（相对风险 0.56，95%CI 0.36 至 0.86；中等确定性证据）和心血管亚最大容量（标准化均数差 0.73，95%CI 0.48 至 0.99；中等确定性证据）。低确定性证据表明，肺康复可能对再加重、呼吸困难和疾病影响有益。关于肺康复对健康相关生活质量和死亡率影响的证据非常不确定（极低确定性证据）。
我们的结果表明，肺康复可能是 AECOPD 患者的一种有效治疗选择，无论环境如何。由于研究规模较小、康复方案异质性、方法学弱点众多以及报告结果不一致，我们对这一证据基础的确定性有限。试验者应遵守最新的报告标准，以加强这一证据基础。
研究方案已在开放科学框架（https://osf.io/amgbz/）中注册。
