Effectiveness of Home‐Based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Meta‐Analysis of Randomized Controlled Trials. Issue 1 (18th June 2013)

• Record Type: Journal Article
• Authors: Liu, Xian‐Liang; Tan, Jing‐Yu; Wang, Tao; Zhang, Qi; Zhang, Min; Yao, Li‐Qun; Chen, Jin‐Xiu
• Is Part Of: Rehabilitation nursing. Volume 39:Issue 1(2014)
• Page Start: 36
• Page End: 59
• Publication Date: 2013-06-18
• Subjects: Rehabilitation nursing -- Periodicals; Nursing -- Periodicals; Rehabilitation -- Periodicals; Soins infirmiers en réadaptation -- Périodiques; 610.73
• DOI: 10.1002/rnj.112
• Languages: English
• ISSNs: 0278-4807

Abstract

<abstract abstract-type="main" id="rnj112-abs-0001"> <title>Abstract</title> <sec id="rnj112-sec-0001" sec-type="section"> <title>Purpose</title> <p>The pulmonary rehabilitation program has become a cornerstone in the management of patients with chronic obstructive pulmonary disease (COPD). Programs based in hospital and treatment facilities, however, are inconvenient and underutilized. A home‐based program is a promising alternative, but studies of its effectiveness have yielded inconsistent results.</p> <p>The purpose of this study is to evaluate the impact of home‐based pulmonary rehabilitation programs on health‐related quality of life (HRQoL) and other health outcomes in patients with COPD.</p> </sec> <sec id="rnj112-sec-0002" sec-type="section"> <title>Methods</title> <p>Randomized controlled trials (RCTs) of home‐based pulmonary rehabilitation programs published between February 1991 and February 2012 were retrieved from electronic databases (PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure [CNKI], and Wanfang Database). Two reviewers independently assessed topical relevance and trial quality, extracted data for meta‐analysis using the Review Manager v5.1 software, and contacted the original studies' authors for additional information.</p> </sec> <sec id="rnj112-sec-0003" sec-type="section"> <title>Findings</title> <p>Eighteen trials, comprising 733 randomized patients, were included in the meta‐analysis. COPD patients experienced significant relief in dyspnea status, measured by the Borg score (Fixed effects model, WMD = −0.92, 95% CI: −1.61~−0.23, <italic>p</italic> = .009) and baseline dyspnea index (BDI) (Fixed effects model, WMD = −1.77, 95% CI: −2.65~−0.89, <italic>p</italic> < .0001) after 12 weeks of home‐based intervention. Home‐based intervention also improved patients' HRQoL scores, measured by the Chronic Respiratory Questionnaire (CRQ) and St. George's Respiratory Questionnaire (SGRQ) (Fixed effects model, WMD = −11.33, 95% CI: −16.37~−6.29, <italic>p</italic> < .0001, SGRQ total scores after 12 weeks of intervention); exercise capacity (measured by the 6‐minute walking distance test (6MWD) (Fixed effects model, WMD = 35.88, 95% CI: 9.38~62.38, <italic>p</italic> = .008, after 12 weeks of intervention); and pulmonary functions (measured by forced expiratory volume in one‐second/forced vital capacity (FEV<sub>1</sub>/FVC) [Random effects model, WMD = −10.72, 95% CI: −15.86~−5.58, <italic>p</italic> < .0001, after 12 weeks of intervention), as compared with the nonintervention control group; however, no statistically significant changes were seen in maximal workload, hospital admission, cost of care, or mortality between the two groups.</p> </sec> <sec id="rnj112-sec-0004" sec-type="section"> <title>Conclusions and Clinical Relevance</title> <p>Home‐based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD‐associated respiratory symptoms and improving HRQoL and exercise capacity. Rigorously designed, large‐scale RCTs are still needed to identify an optimal standard home‐based pulmonary rehabilitation program.</p> </sec> </abstract>