TY - JOUR
T1 - Effectiveness of home-based pulmonary rehabilitation
T2 - systematic review and meta-analysis
AU - Uzzaman, Nazim
AU - Agarwal, Dhiraj
AU - Chan, Soo Chin
AU - Patrick Engkasan, Julia
AU - Habib, Monsur
AU - Hanafi, Nik Sherina
AU - Jackson, Tracy
AU - Jebaraj, Paul
AU - Khoo, Ee Ming
AU - Tahirah Mirza Mohd Tahir , Fatim
AU - Pinnock, Hilary
AU - Shunmugam, Ranita Hisham
AU - Rabinovich, Roberto
N1 - Funding Information:
We acknowledge the contribution of Su May Liew (University of Malaya, Kuala Lumpur, Malaysia) who was a core member of the team until her untimely death in December 2021.Support statement: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Government. The RESPIRE collaboration comprises the UK Grant holders, Partners and research teams as listed on the RESPIRE website (www.ed.ac.uk/usher/respire). T. Jackson is part-funded by the NIHR Global Health Research Unit on Respiratory Health (RESPIRE). G.M.M. Habib has a NIHR RESPIRE PhD studentship and M.N. Uzzaman holds a PhD studentship nested in the IMP2 ART programme at the University of Edinburgh. D. Agarwal holds an NIHR RESPIRE Fellowship. H. Pinnock, R.A. Rabinovich, E.M. Khoo, S.C. Chan, J. Patrick Engkasan, N.S. Hanafi are co-investigators of NIHR RESPIRE-funded pulmonary rehabilitation feasibility studies in their respective centres.
Funding Information:
Conflict of interest: M.N. Uzzaman has nothing to disclose. D. Agarwal has nothing to disclose. S.C. Chan has nothing to disclose. J. Patrick Engkasan has nothing to disclose. G.M.M. Habib owns a Pulmonary Rehabilitation clinic in Bangladesh. N.S. Hanafi has nothing to disclose. T. Jackson has nothing to disclose. P. Jebaraj has nothing to disclose. E.M. Khoo reports grants from UK National Institute for Health Research (NIHR) Global Health Research Unit, during the conduct of the study; personal fees from AstraZeneca, personal fees and non-financial support from GlaxoSmithKline plc, and grants from Seqirus UK Ltd, and is President of the International Primary Care Respiratory Group, UK, outside the submitted work. F.T. Mirza has nothing to disclose. H. Pinnock reports grants from National Institute of Health Research (16/136/109 (2017-2021), during the conduct of the study. R.H. Shunmugam has nothing to disclose. R.A. Rabinovich has nothing to disclose.
Publisher Copyright:
© The authors 2022.
PY - 2022/9/20
Y1 - 2022/9/20
N2 - INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87). CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.
AB - INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87). CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.
KW - Exercise
KW - Exercise Tolerance
KW - Humans
KW - Pulmonary Disease, Chronic Obstructive/diagnosis
KW - Quality of Life
U2 - 10.1183/16000617.0076-2022
DO - 10.1183/16000617.0076-2022
M3 - Article
C2 - 36130789
SN - 0905-9180
VL - 31
JO - European Respiratory Review
JF - European Respiratory Review
IS - 165
M1 - 220076
ER -
