Abstract
AbstractPulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.
Funder
DH | National Institute for Health Research
NIHR Global Health Research Unit on Respiratory Health
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Pulmonary and Respiratory Medicine
Reference90 articles.
1. Ahmed, R., Robinson, R. & Mortimer, K. The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa. Malawi Med. J. 29, 203–211 (2017).
2. Shayo, F. K. & Bintabara, D. Are Tanzanian health facilities ready to provide management of chronic respiratory diseases? An analysis of national survey for policy implications. PLoS ONE 14, e0210350 (2019).
3. World Health Organisation. Global alliance against chronic respiratory diseases. Global surveillance, prevention and control of chronic respiratory diseases. A comprehensive approach. https://www.who.int/respiratory/en/ (2007).
4. Ferkol, T. & Schraufnagel, D. The global burden of respiratory disease. Ann. Am. Thorac. Soc. 11, 404–406 (2014).
5. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob. Health 6, e1363–e1374 (2018).
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