Intervention Review

Pulmonary rehabilitation for chronic obstructive pulmonary disease

  1. Yves Lacasse1,*,
  2. Roger Goldstein2,
  3. Toby J Lasserson3,
  4. Sylvie Martin4

Editorial Group: Cochrane Airways Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 15 JUN 2006

DOI: 10.1002/14651858.CD003793.pub2

Database Title

Additional Information

How to Cite

Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858.CD003793.pub2.

Author Information

  1. 1

    Institut universitaire de cardiologie et de pneumologie de Québec(Hospital Laval), Québec,, Quebec,, Canada

  2. 2

    West Park Hospital, Division of Respiratory Medicine, Toronto, Ontario, Canada

  3. 3

    St George's, University of London, Community Health Sciences, London, UK

  4. 4

    Institut universitaire de cardiologie et de pneumologie de Québec (Hôpital Laval), Centre de recherche, Québec,, Québec,, Canada

*Yves Lacasse, Institut universitaire de cardiologie et de pneumologie de Québec(Hospital Laval), 2725 Chemin Sainte-Foy, Québec,, Quebec,, G1V 4G5, Canada. Yves.Lacasse@med.ulaval.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The widespread application of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported in 2001.

Objectives

To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD.

Search methods

We identified additional RCTs from the Cochrane Airways Group Specialised Register. Searches were current as of July 2004.

Selection criteria

We selected RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least four weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation.

Data collection and analysis

We calculated weighted mean differences (WMD) using a random-effects model. We requested missing data from the authors of the primary study.

Main results

We included the 23 randomized controlled trials (RCTs) in the 2001 Cochrane review. Eight additional RCTs (for a total of 31) met the inclusion criteria. We found statistically significant improvements for all the outcomes. In four important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue, Emotional function and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units (for example: Dyspnoea score: WMD 1.0 units; 95% confidence interval: 0.8 to 1.3 units; n = 12 trials). Statistically significant improvements were noted in two of the three domains of the St. Georges Respiratory Questionnaire. For FEC and MEC, the effect was small and slightly below the threshold of clinical significance for the six-minute walking distance (WMD: 48 meters; 95% CI: 32 to 65; n = 16 trials).

Authors' conclusions

Rehabilitation relieves dyspnea and fatigue, improves emotional function and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. Rehabilitation forms an important component of the management of COPD.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pulmonary rehabilitation for chronic obstructive pulmonary disease

We report the second update of a meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. We wished to determine the impact of rehabilitation (defined as exercise training for at least four weeks with or without education and/or psychological support) on quality of life (QoL) and exercise capacity. We included 31 randomised controlled trials. Statistically significant improvements were found for all the outcomes. In four important domains of QoL (dyspnea, fatigue, emotions and patients' control over disease), the effect was larger than the minimal clinically important difference. These results strongly support respiratory rehabilitation as part of the spectrum of management for patients with COPD.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

慢性阻塞性肺病的肺部復健

肺部復健在被廣泛應用於慢性阻塞性肺病(COPD)之前該等治療計畫應先呈現能令功能改善。本回顧的更新版是在2001年報導。

目標

確認復健對COPD患者健康相關的生活品質(QoL)及運動能力的影響。

搜尋策略

我們自Cochrane Airway Group Specialised Register鑑定出更多隨機對照試驗。目前搜尋至2004年7月。

選擇標準

我們選擇測量接受復健之COPD病人的生活品質(QoL)及/或功能性(FEC)或最大(MEC)運動能力的隨機對照試驗。復健的定義為至少4週可有或沒有教育及/或心理學支持的運動訓練。控制組接受受傳統社區照護而無復健。

資料收集與分析

我們使用隨機效應模式計算權重平分差(WMD)，我們向原研究作者徵詢遺漏的數據。

主要結論

在2001年的Cochrane回顧中，我們納入23項隨機對照試驗(RCTS)，另外，八項KCTS(共31項)亦符合納入標準。我們發現所有治療效果均有統計學意義的進步。在四項重要的QoL領域中(呼吸困難、倦怠、情緒功能及控制之慢性呼吸問卷評分)，其效應超過最小的臨床重要性差異0.5單位(如：呼吸困難評分：WMD1.0單位，95%信賴區間：0.8至1.3單位；n = 12項試驗)。聖喬治呼吸問卷三領域中有二項呈現統計學有意義的進步。而FEC及MEC則效應不大而在六分鐘步行距離測試中稍低於臨床意義的閾值(WMD：48米；95%CI：32至65；n = 16試驗) (WMD 23.07 cmH2O，95%CI 15.655430.50)。

作者結論

復健可緩解呼吸困難及倦怠、改善情緒功能及加強病人控制自我狀況的感覺。這些進步乃中等程度而在臨床上有意義。復健已成為治療COPD的一個重要部分。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

我們報告慢性阻塞性肺病肺部復健綜合分析的第二次更新版本。我們希望確認復健(定義為至少四週可有或沒有教育及/或心理學支持的運動訓練)對生活品質(QoL)及運動能力的影響。我們納入31項隨機對照試驗。所有的治療效果均呈現統計學意義的進步。在四項重要的QoL領域中(呼吸困難、倦怠、情緒及病人對病情的控制)，其效應超過最小的臨床重要性差異。這些結果強烈支持呼吸復健作為治療COPD病人各種療法的一部分。

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