Physiotherapy Department, Alfred Health, Melbourne, Australia.
Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia.
Chron Respir Dis. 2024 Jan-Dec;21:14799731241277808. doi: 10.1177/14799731241277808.
To determine the proportion of people who achieve minimal clinically important differences (MCID) with centre-based or home-based pulmonary rehabilitation and to synthesise data on adverse events. Cochrane reviews and electronic databases were searched to identify randomised trials comparing centre-based to home-based pulmonary rehabilitation, or either model to usual care, in people with chronic respiratory disease. Primary outcomes were the proportion of participants achieving MCIDs in exercise capacity and disease-specific quality of life. Secondary outcomes were symptoms and adverse events. Cochrane Risk of Bias 1.0 and GRADE were used to assess the risk of bias and certainty of evidence respectively. Forty-nine trials were eligible. Compared to usual care, a higher proportion of pulmonary rehabilitation participants achieved the MCID for exercise capacity (6MWT: 47% vs 20%, = 0.11), dyspnoea (43% vs 29%, = 0.0001), fatigue (48% vs 27%, = 0.0002) and emotional function (37% vs 25%, = 0.02), with all of these between group differences statistically significant except for exercise capacity. There were no differences between centre-based and home-based pulmonary rehabilitation in the proportion of participants who achieved MCIDs (34%- 58% across studies). Ninety percent of trials reported no adverse events. Certainty of evidence was low-to- moderate with all outcomes except for CRQ-mastery (centre-based vs home-based pulmonary rehabilitation, or pulmonary rehabilitation vs usual care in COPD), ESWT (pulmonary rehabilitation vs usual care in COPD) and 6MWT (pulmonary rehabilitation vs usual care in bronchiectasis) where evidence was very uncertain. Clinically meaningful outcomes are achieved by similar proportions of participants in centre-based and home-based pulmonary rehabilitation, with few adverse events. Reporting of trial outcomes according to MCIDs is necessary for informed decision making regarding pulmonary rehabilitation models.
为了确定以中心为基础或家庭为基础的肺康复治疗中达到最小临床重要差异（MCID）的患者比例，并综合有关不良事件的数据。 Cochrane 系统评价和电子数据库搜索旨在比较以中心为基础的肺康复治疗与家庭为基础的肺康复治疗，或任何一种模式与常规护理治疗慢性呼吸道疾病患者的随机试验。主要结局是运动能力和疾病特异性生活质量方面达到 MCID 的参与者比例。次要结局是症状和不良事件。使用 Cochrane 偏倚风险 1.0 和 GRADE 分别评估偏倚风险和证据确定性。有 49 项试验符合条件。与常规护理相比，肺康复治疗的参与者达到运动能力（6MWT：47%比 20%， = 0.11）、呼吸困难（43%比 29%， = 0.0001）、疲劳（48%比 27%， = 0.0002）和情绪功能（37%比 25%， = 0.02）MCID 的比例更高，除了运动能力，所有这些组间差异均具有统计学意义。在达到 MCID 的参与者比例方面，中心为基础和家庭为基础的肺康复治疗之间没有差异（各项研究中为 34%-58%）。90%的试验报告无不良事件。除了 CRQ-掌握（中心为基础的肺康复治疗与家庭为基础的肺康复治疗，或肺康复治疗与 COPD 中的常规护理）、ESWT（COPD 中的肺康复治疗与常规护理）和 6MWT（支气管扩张症中的肺康复治疗与常规护理）外，所有结局的证据确定性均为低至中等，这些结局的证据非常不确定。中心为基础和家庭为基础的肺康复治疗中达到相似比例的参与者可获得有临床意义的结局，且不良事件较少。根据 MCID 报告试验结局对于做出关于肺康复治疗模式的知情决策是必要的。
