Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease
Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease
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DOI：
10.1016/s0140-6736(96)04201-8
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发表时间：
1996-10-26
期刊：
影响因子：
168.9
通讯作者：
Goldstein, RS
中科院分区：
文献类型：
--
作者：
Lacasse, Y;Wong, E;Goldstein, RS
背景呼吸康复越来越被认为是慢性阻塞性肺疾病（COPD）患者管理的重要组成部分，在广泛应用此类计划之前，应提供直接归因于功能改善的证据。我们评估了呼吸康复对COPD患者运动能力和健康相关生活质量（HRQL）的影响。方法我们对COPD患者呼吸康复的随机对照试验进行了荟萃分析，评估功能或最大运动能力，HRQL，或两者兼而有之。呼吸康复定义为运动训练（至少4周），有或没有教育，心理支持，或两者兼而有之。HRQL最常用的测量方法是慢性呼吸问卷，其中的回答以7分量表表示。对照组不接受康复治疗。在每项试验中，计算每种结局的效应量;然后通过随机效应模型合并效应量。治疗的总体效果进行了比较，其最小的临床重要的差异（MCID）-定义为最小的差异被认为是重要的平均patient.Findings我们包括14项试验。所有结果都有显著改善。对于HRQL的两个重要特征，呼吸困难和掌握，总体治疗效果大于MCID：1。0（95%CI 0. 6-1. 5)乙腈-0. 8（0. 5-1. 2），分别与0. 5.对于功能性运动能力（g-min步行试验），总体效果为55。7米（27. 8-92. 8），和最大运动能力（增量自行车测力计测试），8。3 W（2. 8-16. 5）。功能性运动能力表现出异质性，不能解释的敏感性analysis.Interpretation呼吸康复缓解呼吸困难，提高控制COPD。这些改善在临床上很重要。运动能力提高的价值尚不清楚。呼吸康复是COPD患者护理的有效组成部分。
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 (g-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 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.