PMID- 8888163
OWN - NLM
STAT- MEDLINE
DCOM- 19961203
LR  - 20220330
IS  - 0140-6736 (Print)
IS  - 0140-6736 (Linking)
VI  - 348
IP  - 9035
DP  - 1996 Oct 26
TI  - Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary 
      disease.
PG  - 1115-9
AB  - BACKGROUND: Respiratory rehabilitation is increasingly recognised as an important 
      part of the management of patients with chronic obstructive pulmonary disease 
      (COPD). The widespread application of such programmes should be preceded by 
      evidence of directly attributable improvements in function. We assessed the 
      effect of respiratory rehabilitation on exercise capacity and health-related 
      quality of life (HRQL) in patients with COPD. METHODS: We carried out a 
      meta-analysis of randomised controlled trials of respiratory rehabilitation in 
      patients with COPD that assessed functional or maximal exercise capacity, HRQL, 
      or both. Respiratory rehabilitation was defined as exercise training (for at 
      least 4 weeks) with or without education, psychological support, or both. The 
      most commonly used measure for HRQL was the chronic respiratory questionnaire, in 
      which responses were presented on a 7-point scale. The control groups received no 
      rehabilitation. Within each trial and for each outcome an effect size was 
      calculated; the effect sizes were then pooled by a random-effects model. The 
      overall effect of treatment was compared with its minimum clinically important 
      difference (MCID)--defined as the smallest difference perceived as important by 
      the average patient. FINDINGS: We included 14 trials. Significant improvements 
      were found for all the outcomes. For two important features of HRQL, dyspnoea and 
      mastery, the overall treatment effect was larger than the MCID: 1.0 (95% CI 
      0.6-1.5) and 0.8 (0.5-1.2), respectively, compared with an MCID of 0.5. For 
      functional exercise capacity (6-min walk test), the overall effect was 55.7 m 
      (27.8-92.8), and for maximum exercise capacity (incremental cycle ergometer 
      test), 8.3 W (2.8-16.5). Functional exercise capacity showed heterogeneity that 
      could not be explained by the sensitivity analyses. INTERPRETATION: Respiratory 
      rehabilitation relieves dyspnoea and improves the control over COPD. These 
      improvements are clinically important. The value of the improvement in exercise 
      capacity is not clear. Respiratory rehabilitation is an effective part of care in 
      patients with COPD.
FAU - Lacasse, Y
AU  - Lacasse Y
AD  - Department of Clinical Epidemiology, McMaster University, Hamilton, Canada.
FAU - Wong, E
AU  - Wong E
FAU - Guyatt, G H
AU  - Guyatt GH
FAU - King, D
AU  - King D
FAU - Cook, D J
AU  - Cook DJ
FAU - Goldstein, R S
AU  - Goldstein RS
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - England
TA  - Lancet
JT  - Lancet (London, England)
JID - 2985213R
SB  - IM
CIN - ACP J Club. 1997 Mar-Apr;126(2):38
CIN - Lancet. 1996 Oct 26;348(9035):1111-2. PMID: 8888159
CIN - Lancet. 1996 Dec 14;348(9042):1661. PMID: 8962009
CIN - Lancet. 1997 Jan 25;349(9047):285. PMID: 9014937
MH  - *Exercise Therapy
MH  - Humans
MH  - Lung Diseases, Obstructive/*rehabilitation
MH  - Quality of Life
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
EDAT- 1996/10/26 00:00
MHDA- 1996/10/26 00:01
CRDT- 1996/10/26 00:00
PHST- 1996/10/26 00:00 [pubmed]
PHST- 1996/10/26 00:01 [medline]
PHST- 1996/10/26 00:00 [entrez]
AID - S0140-6736(96)04201-8 [pii]
AID - 10.1016/S0140-6736(96)04201-8 [doi]
PST - ppublish
SO  - Lancet. 1996 Oct 26;348(9035):1115-9. doi: 10.1016/S0140-6736(96)04201-8.