METAANALYSIS OF RESPIRATORY REHABILITATION IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Background Respiratory rehabilitation is increasingly recognised as an important part of the management of patients with chronic obstructive pulmonary disease (COPD), The widespread application of such programm es should be preceded by evidence of directly attributable improvement s in function. We assessed the effect of respiratory rehabilitation on exercise capacity and health-related quality of life (HRQL) in patien ts with COPD. Methods We carried out a meta-analysis of randomised con trolled trials of respiratory rehabilitation in patients with COPD tha t assessed functional or maximal exercise capacity, HRQL, or both. Res piratory rehabilitation was defined as exercise training (for at least 4 weeks) with or without education, psychological support, or both. T he most commonly used measure for HRQL was the chronic respiratory que stionnaire, in which responses were presented on a 7-point scale. The control groups received no rehabilitation. Within each trial and for e ach outcome an effect size was calculated; the effect sizes were then pooled by a random-effects model. The overall effect of treatment was compared with its minimum clinically important difference (MCID)-defin ed as the smallest difference perceived as important by the average pa tient. Findings We included 14 trials. Significant improvements were f ound for all the outcomes. For two important features of HRQL, dyspnoe a and mastery, the overall treatment effect was larger than the MCID: 1 . 0 (95% CI 0 . 6-1 . 5) and 0 . 8 (0 . 5-1 . 2), respectively, comp ared with an MCID of 0 . 5. For functional exercise capacity (g-min wa lk test), the overall effect was 55 . 7 m (27 . 8-92 . 8), and for max imum exercise capacity (incremental cycle ergometer test), 8 . 3 W (2 . 8-16 . 5). Functional exercise capacity showed heterogeneity that co uld not be explained by the sensitivity analyses. Interpretation Respi ratory rehabilitation relieves dyspnoea and improves control over COPD . These improvements are clinically important. The value of the improv ement in exercise capacity is not clear. Respiratory rehabilitation is an effective part of care in patients with COPD.