Systematic review of clinical effectiveness, component and delivery of pulmonary rehabilitation in low-resource settings

G M Monsur Habib, Roberto A Rabinovich, Kalyani Divgi, Salahuddin Ahmed, Samir Kumar Saha, Sally Singh, Aftab Uddin , Nazim Uzzaman, Hilary Pinnock

Research output: Contribution to journalArticlepeer-review

Abstract

Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high resource settings. In low- and middle-income countries PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; prepublication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality-of-life (HRQoL), breathlessness; included components; and mode of delivery. We used Cochrane Risk-of-Bias (RoB) to assess study quality, and synthesised data narratively. From 8912 hits we included 13 studies; 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, breathing exercises. Low cost services adapted to the setting, used limited equipment, and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
Original languageEnglish
Pages (from-to)52
Journalnpj Primary Care Respiratory Medicine
Volume30
Issue number1
DOIs
Publication statusPublished - 19 Nov 2020

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