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Centre for Evidence-
Based Medicine

Upper Abodominal Surgery - Periop physio decreases postop pulmonary complications

Clinical Bottom Line

Respiratory rehabilitation that includes at least 4 weeks of exercise training relieves dyspnea and improves control over COPD

Citation

Lacasse Y, Wong E, Guyatt GH, King D, Cook DJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996;348:1115-9.

Clinical Question

In a patient with COPD, does an in-patient pulmonary rehabilitation program improve strength, endurance, and quality of life?

Search Terms

You search MEDLINE using the terms 'pulmonary rehabilitation' and 'chronic obstructive lung disease' and find a promising systematic review.

The Study

Systematic review of 14 RCTs of respiratory rehabilitation programs. The respiratory program for patients with a diagnosis of COPD, had to have been compared with conventional community care or other interventions that were unlikely to affect exercise capacity or quality of life.

The Evidence

Significant improvements were found for maximum exercise capacity, functional exercise capacity, and health related quality of life (HRQL). The pooled effect size for maximum exercise capacity was 0.3 SD units (0.1 to 0.6) and corresponded to 8.3 watts (2.8 to 16.5) on a cycle ergometer test. For functional exercise capacity, the pooled effect size was 0.6 SD units (0.3 to 1.0) corresponding to 55.7 meters (27.8 to 92.8) on a six minute walk test. For two aspects of HRQL (dyspnoea and mastery), the overall treatment effect was larger than the minimal important clinical difference, 1.0 (0.6 to 1.5) and 0.8 (0.5 to 1.2) respectively. The results for functional exercise capacity showed heterogeneity unexplained by sensitivity analysis.

Comments

Patients with multiple health problems were excluded from the trials. The most common exclusion criteria were ischaemic heart disease, heart failure, intermittent claudication, disabling musculoskeletal problems, and at home oxygen use.

Appraised By

Mary Ann O'Brien

Expiry Date

January 2001.