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Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis

Uzzaman MN 1 , Agarwal D 2 , Chan SC 3 , Patrick Engkasan J 3 , Habib GMM 4 , Hanafi NS 3 Show all authors , Jackson T 1 , Jebaraj P 5 , Khoo EM 3 , Mirza FT 6 , Pinnock H 1 , Shunmugam RH 7 , Rabinovich RA 8

Affiliations 

  • 1 NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
  • 2 Vadu Rural Health Program, KEM Hospital and Research centre, Pune, India
  • 3 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 4 Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
  • 5 Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, India
  • 6 Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
  • 7 Library, University of Malaya, Kuala Lumpur, Malaysia
  • 8 MRC Centre for Information Research, University of Edinburgh, Edinburgh, UK roberto.rabinovich@ed.ac.uk
Eur Respir Rev, 2022 Sep 30;31(165).
PMID: 36130789 DOI: 10.1183/16000617.0076-2022

Abstract

INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care.

METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence.

RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87).

CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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