Assessing the Impact of Pulmonary Rehabilitation on Health Outcomes in COPD Patients: A Systematic Review
DOI:
https://doi.org/10.55712/98f1x782Keywords:
Chronic Obstructive Pulmonary Disease, Pulmonary Rehabilitation, Exercise Capacity, Quality of Life, Health OutcomesAbstract
Pulmonary rehabilitation (PR) is a core non-pharmacological intervention for chronic obstructive pulmonary disease (COPD), yet the optimal programme duration, the ideal timing and setting for starting pulmonary rehabilitation, and factors driving programme completion and adherence remain unclear. This review was conducted to synthesise current evidence on effectiveness of pulmonary rehabilitation in improving exercise capacity and quality of life in patients with COPD and to appraise the methodological strengths and weaknesses of the existing evidence base. Literature was analysed, including only peer-reviewed quantitative research papers published between January 2015 and December 2024, encompassing randomised controlled trials, cohort studies, quasi-experimental designs, and pilot studies. Critical Appraisal Skills Programme (CASP) checklist for quantitative research was employed to evaluate each of the shortlisted papers, narrowing down to a final fifteen papers for review. Pulmonary rehabilitation was consistently associated with improvements in exercise capacity, respiratory muscle strength, dyspnoea, and quality of life in individuals with COPD. Psychological advantages, such as reduced anxiety and depression, are also prevalent. Evidence indicates that exercise capacity improves within four weeks; eight-week pulmonary rehabilitation programmes are equally successful as twelve-week programmes, providing flexible alternatives, depending on patient needs, socio-economic context and availability of resources. Early initiation of pulmonary rehabilitation within two weeks of an exacerbation was associated with reduced hospital readmissions and reduced duration of hospital stays. Innovative rehabilitation methods such as Tai Chi, yoga, and singing therapy provide feasible alternatives. Phone supervised, home-based, and online interventions such as hybrid virtual coaching and nurse-led initiatives have been studied at conceptual level with varying levels of physical and psychological improvements. Health economics, hospital admission rates, length of hospital stays and mortality need to be studied through long-term follow-up studies for rehabilitative interventions, with particular attention to improve long-term adherence and accessibility to PR. Certain studies indicate cognitive advantages when physical rehabilitation is integrated with cognitive training. Nonetheless, methodological constraints, like limited sample numbers and brief follow-up periods, underscore the necessity for more stringent studies. Future research must emphasise extensive, longitudinal controlled trials to enhance evidence and plan to introduce strategies to promote enduring adherence.
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