International Journal of COPD (Dec 2021)
Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
Abstract
Dong Zhang,1– 3 Hailong Zhang,1– 3 Xuanlin Li,1– 3 Siyuan Lei,1– 3 Lu Wang,1– 3 Wen Guo,1– 3 Jiansheng Li1– 3 1Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China; 2Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China; 3Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, People’s Republic of ChinaCorrespondence: Jiansheng Li Tel/Fax +86-371-65676568Email [email protected]: To evaluate the efficacy and safety of early pulmonary rehabilitation (PR) (ie, < 3 days of hospitalization) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods: Embase, Web of Science, PubMed and Cochrane Library were searched from their inception to 1 April 2021. Randomized controlled trials were included if they observed the efficacy of early PR in AECOPD patients. Study selection, data extraction, risk of bias and quality of evidence were assessed by two researchers independently. Assessment of the risk of bias and eidence quality were evaluated by the Cochrane Collaboration’s tool and Grading of Recommendations, Assessment, Development and Evaluation system, respectively.Results: Fourteen trials (829 participants) were identified. Significant improvement was found in the 6-minute walk distance (6MWD; mean difference (MD): 69.64; 95% CI: 40.26 to 99.01; Z = 4.65, P < 0.0001, low quality). In the subgroup analysis, the exercise-training group showed marked improvement (MD: 96.14; 95% CI: 20.24 to 172.04; Z = 2.48, P = 0.001). The Saint George’s Respiratory Questionnaire (SGRQ) total score was low (MD: − 12.77; 95% CI: − 16.03 to − 9.50; Z = 7.67, P < 0.0001, moderate quality). Significant effects were not found for the duration of hospital stay, quadriceps muscle strength or five times sit to stand test. Only one serious adverse event was reported in experimental group, which was not associated with early PR.Conclusion: PR initiated < 3 days of hospitalization may increase exercise capacity and improve quality of life, but the results should be interpreted prudently and dialectically, and the role of early PR in AECOPD needs further exploration.Keywords: chronic obstructive pulmonary disease, acute exacerbation, pulmonary rehabilitation, meta-analysis
