A Cochrane review including 20 studies with a total of 1 477 subjects considered the effects of pulmonary rehabilitation after acute exacerbations of chronic obstructive pulmonary disease (COPD). Rehabilitation programmes showed great diversity (number of completed exercise sessions; type, intensity and supervision), patient education (from none to extensive self-management programmes) and how they were organised. Rehabilitation significantly reduced hospital admissions (table ). Intervention improved health-related quality of life measured by St. Georges Respiratory Questionnaire total score (SGRQ) and exercise capacity (six-minute walk test) (table ). Rehabilitation did not show an effect on mortality, but trials were underpowered to detect an effect and none used mortality as a primary outcome.
| Outcome | Relative effect (95% CI) | Risk with control | Risk with intervention - Rehabilitation (95% CI) | No of participants (studies), Quality of the evidence |
|---|---|---|---|---|
| Hospital readmission (follow-up, median 9 months) | OR 0.44 (0.21 to 0.91) | 500 / 1000 | 306 / 1000 (174 to 476) | 810 (8), Moderate |
| Mortality (follow-up, median 12 months) | OR 0.68 (0.28 to 1.67) | 150 / 1000 | 107 / 1000 (47 to 228) | 670 (6), Low |
| Health-related quality of life: SGRQ: total score (follow-up, median 5 months), a lower score indicates better quality of life | - | Score at beginning of rehabilitation around 65 | Mean change from baseline in score 7.80 units lower (95% CI -12.12 to -3.47) | 1003 (8), High |
| Change from baseline in 6-minute walking test (follow-up, median 3 months) | - | Distance at beginning around 300 m | Mean change from baseline 62.38 metres more (95% CI 38.45 to 86.31) | 819 (13), High |