A pre–post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda

Abstract

Rupert Jones,1 Bruce J Kirenga,2 Wincelsas Katagira,2 Sally J Singh,3 Jill Pooler,4 Alphonse Okwera,2 Richard Kasiita,5 Doyo G Enki,6 Siobhan Creanor,6 Andy Barton4 1Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK; 2Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda; 3Cardio-Respiratory Directorate, University Hospitals of Leicester NHS Trust, Leicester, 4Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK; 5Department of Physiotherapy, Mulago Hospital, Kampala, Uganda; 6Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK Setting: The study was conducted at Mulago Hospital, Kampala, Uganda.Objective: As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD).Design: In a pre–post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken.Results: In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR.Conclusion: PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD. Keywords: tuberculosis, exercise training, self-management, nonpharmacological intervention 

Keywords

• Tuberculosis
• Exercise training
• Self-management
• Non-pharmacological intervention