Chest
Original Research: COPDPulmonary Rehabilitation as a Mechanism to Reduce Hospitalizations for Acute Exacerbations of COPD: A Systematic Review and Meta-Analysis
Section snippets
Methods
We used methods as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.12 A protocol was devised for the search strategy and is included in e-Appendix 1.
Results of the Searches
The searches yielded > 6,500 studies, and following screening of titles and abstracts, 181 full articles were reviewed. After the full review process, 21 studies were deemed eligible for inclusion. Of these, 18 reported outcomes that could be included in the meta-analysis, including 10 RCTs, three cohort studies, and five studies comparing admissions 1 year before and 1 year after PR (before/after studies). The three studies that were not included in the meta-analysis17, 18, 19 did not report
Discussion
The findings of these studies provide evidence that PR reduces hospitalizations for AECOPD in the short-term. Results from RCTs and cohort studies showed lower admission rates after rehabilitation compared with usual care. Additionally, studies that compared COPD hospital admission numbers before and after PR showed an overall reduction in admission rates. After a sensitivity analysis that included studies that looked at stable COPD, the same pattern was found.
Only one study did not favor PR
Conclusions
PR is an extremely valuable intervention for improving many aspects of the lives of patients with COPD. This review provides some evidence to suggest that providing rehabilitation is beneficial for reducing hospitalizations and therefore health-care consumption. Evidence has shown that hospital admissions after a course of PR are lower than before therapy. Also, when compared with usual care, admissions can be reduced with rehabilitation. However, pooled results from the cohort studies did not
Acknowledgments
Author contributions: M. A. S. and J. K. Q. conceived the study. E. M. and M. A. S. carried out searches, and articles were screened and reviewed by E. M., T. P., and M. A. S. R. N. performed the statistical analyses. E. M. and T. P. produced the first drafts, and all authors contributed to subsequent drafts. M. A. S. and J. K. Q. approved the final version.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. K. Q. reports grants from the Medical Research
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FUNDING/SUPPORT: This study was funded by a research grant from the UK Chartered Society of Physiotherapy.