Significance of Pulmonary Rehabilitation in Improving Quality of Life for Subjects With COPD

BACKGROUND:Increasingly, studies have shown that application of pulmonary rehabilitation (PR) may improve the quality of life (QOL) of patients with COPD. However, some studies remain controversial and were limited to small number of participants. We designed a systematic review and meta-analysis to evaluate the efficacy of PR in improving the QOL for subjects with COPD.METHODS:We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to March 29, 2018, to identify relevant randomized controlled trials that analyzed and evaluated the efficacy of PR in subjects with COPD. Participants were randomly assigned to receive PR (intervention group) or usual care (control group). We used Chronic Respiratory Questionnaire scores, which include 4 important domains (ie, Fatigue, Emotion, Mastery, and Dyspnea) as the evaluating indicators of QOL. Mean differences with 95% CI were estimated to compare the outcomes of the groups. We also performed subgroup analysis for the pooled results of PR effects in subjects with COPD. In addition, a sensitivity analysis was performed to examine the stability of the combined results. Two reviewers assessed trial quality and extracted data independently.RESULTS:Seventeen randomized controlled trials (N = 1,649 participants) were identified for the present analysis. In comparing PR groups with usual care groups, we identified significant effects in QOL improvement as measured by the Chronic Respiratory Questionnaire scores for fatigue (Mean difference 0.60, 95% CI 0.36–0.84, P < .001), mastery (Mean difference 0.59, 95% CI 0.32–0.85, P < .001), and dyspnea (Mean difference 0.70, 95% CI 0.46–0.94, P < .001), but no clinically important improvement was found in emotion (Mean difference 0.45, 95% CI 0.23–0.67, P < .001) according to the minimal clinically important difference that we defined as mean difference ≥ 0.5 units.CONCLUSION:PR may constitute an important component of COPD management and may be beneficial in improving QOL.

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