Table 1

PICOS table for the search strategy

PICOSDescription, inclusionExclusion criteriaOperational rules
Population

  • Adults with primary diagnosis of chronic respiratory diseases (CRDs).

  • Age >18 years.

  • Comorbidity will not be an exclusion criterion.

  • Pregnant women and paediatric population.

  • Rehabilitation provided to predominant condition is non-respiratory conditions.

  • Recovery from acute infections or injury (eg, immediately post-COVID) until the condition has been stable for 6 months.

  • Conference abstract.

  • Lung cancer.

  • Pulmonary hypertension.

PR delivered to people with CRDs such as chronic obstructive pulmonary disease (COPD), remodelled asthma, pulmonary impairment after tuberculosis (PIAT), bronchiectasis, interstitial lung disease (ILD), cystic fibrosis (CF), stable post-COVID (but excluding post-intensive care unit rehabilitation) will be studied. We will also include PR delivered to people with more than one CRD, or undifferentiated chronic respiratory conditions.
InterventionHome-pulmonary rehabilitation (PR) which comprises both exercise and at least one non-exercise component for a duration not lesser than 4 weeks.Formal hospital or community medical centre-based programmes.‘Home-PR’—the key criterion is that the sessions are undertaken by an individual by themselves (though a family member may be involved) and typically at home. Apart from baseline and post-PR assessments,35 the patient does not attend a centre (either a hospital centre or a local ‘satellite’ centre) and is not supervised face-to-face by a healthcare professional (though there may be remote communication from a healthcare professional for some or all of the session).
Exercise sessions typically include aerobic, endurance, resistance and reconditioning exercises, though local resources and preferences may include other exercise modalities. Non-exercise components commonly include patient education, energy conservation training, smoking cessation, psychological support, self-management skill development or other recognised PR interventions along with optimisation of pharmacotherapy.
ComparisonEither population receiving ‘Centre-PR’ or receiving ‘Usual care’.No control groups.‘Centre-PR’—the key criterion is that the sessions are under direct healthcare professional’s supervision. The ‘Centre’ can be in a hospital, community setting, or remote facility. Centre-based sessions are normally group-based (though it is recognised that this may be modified in the context of a pandemic). Telehealth services where patients attend a supervised satellite Centre would be considered as Centre-PR.
‘Usual care’—is the standard care received by individual with CRD in the relevant healthcare system but excluding the exercise components of PR.
OutcomesConsist of either one of the following outcome measures

  • Health-related quality of life (HRQoL).

  • Functional exercise capacity.


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Additional outcome(s)

  • Uptake of the service, completion rates.

  • Assessment of motivation/others intermediate outcome.

  • Activities of daily living.

  • Physical activity level.

  • Symptom control.

  • Psychological status.

  • Healthcare burden, for example, exacerbation rates, hospitalisation, etc.

  • Adverse effect.

Not including HRQoL or any measurement of exercise capacity as outcome.Validated instruments will be considered:

  • HRQoL: St Georges Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), EuroQol Five Dimension (EQ-5D).

  • Functional exercise capacity: 6-minute walk test (6MWT), incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT). We will also include step tests and sit-to-stand tests that are sometimes used in Home-PR assessments.45

  • Symptom control: Modified Medical Research Council (mMRC), Clinical COPD Questionnaire (CCQ), Borg scale.

  • Psychological status: Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), State-Trait Anxiety Inventory (STAI), Beck Inventory test.

SettingAny settingsLow or high resource settings irrespective of level of economies of the countries.
Study designsRandomised controlled trials (RCTs); clinical controlled trials (CCTs).Cohort study, case series, case report.We will exclude studies that do not have a control group. We will consider RCTs to answer all of the three research questions (ie, (1) effectiveness, (2) components and (3) completion rate of Home-PR), and consider CCTs to answer research questions 2 and 3.
LanguageNo language restriction.