THE COMPONENTS OF A RESPIRATORY REHABILITATION PROGRAM - A SYSTEMATICOVERVIEW

Objective: To determine the contribution of the various components of a rehabilitation program to the improvement of exercise capacity and h ealth-related quality of life (HRQL) in patients with COPD. Data sourc es: MEDLINE (1966 to April 1996) was searched. Abstracts presented at international conferences were also hand searched for additional relev ant trials. Bibliographies of the retrieved articles were reviewed, Ex perts in rehabilitation were consulted to uncover unpublished trials. Study selection: Randomized controlled trials (RCTs) of exercise train ing, breathing exercises, education, and psychosocial support in patie nts with CORD were primarily included if (1) the treatment effect of a specific component of a rehabilitation program could be isolated, and (2) exercise capacity, HRQL, compliance with medical therapy, and/or knowledge about the disease were measured. Data synthesis: A best-evid ence synthesis was conducted; 22 RCTs contributed to the analysis, We found the following: (1) the patients exposed to interventions that in cluded exercise training improved their functional exercise capacity a nd HRQL; (2) exercise training was muscle specific; (3) the evidence t o support inspiratory muscle training and other breathing exercises as an adjunct to exercise training in CORE remains equivocal; (4) the co ntribution of education has not been well addressed; and (5) psychosoc ial support reduced dyspnea acutely and, when used as an adjunct to re habilitation, promoted compliance with an exercise regimen and improve d HRQL. Conclusion: Respiratory rehabilitation is likely to improve fu nctional exercise capacity and HRQL if it includes exercise training a nd psychosocial support. Further research is required to better define the types and intensity of exercise as well as the influence of respi ratory muscle training and patient education.