Rehabilitación pulmonar para la enfermedad pulmonar intersticial
Referencias
Referencias de los estudios incluidos en esta revisión
Referencias de los estudios excluidos de esta revisión
Referencias de los estudios en espera de evaluación
Referencias de los estudios en curso
Referencias adicionales
Referencias de otras versiones publicadas de esta revisión
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | Sarcoidosis: n = 65 Pulmonary rehabilitation group: n = 30, 12 men, mean age 38 years Control group: n = 35, 14 men, mean age 36 years | |
| Interventions | Pulmonary rehabilitation group: 5‐week multi‐disciplinary exercise programme. Included exercise training (5 times weekly for 40 minutes), physiotherapy, education, nutritional advice and stress management Control group: not specified | |
| Outcomes | Walking test: type unspecified Dyspnoea: measure unspecified HRQoL: WHO questionnaire All measures were obtained before and after intervention period. | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not specified. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | Dust‐related ILD: n = 11, 100% men Pulmonary rehabilitation group: n = 6, mean age 70 (SD 7) years, mean FVC 86 (SD 23) % predicted, mean TLCO 54 (SD 15) % predicted Control group: n = 4, mean age 72 (SD 6) years, mean FVC 86 (SD 18) % predicted, mean TLCO 57 (SD 13) % predicted | |
| Interventions | Pulmonary rehabilitation group: 8‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance exercise (cycling and walking). Initial intensity was at 80% of walking speed on initial 6MWT for walking and 60% of peak work achieved on CPET for cycling. Exercise training was progressed according to protocol. Control group: usual medical management | |
| Outcomes | 6MWT CPET Endurance cycle test SGRQ CRQ mMRC Dyspnoea Scale Physical activity (SenseWear Armband) Measured before and after intervention period. 6MWT and questionnaires repeated at 6‐month follow‐up. | |
| Notes | Supported by Workers' Compensation Dust Diseases Board of New South Wales, Australia. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated randomisation sequence. |
| Allocation concealment (selection bias) | Low risk | Method of concealment not described within paper. Authors confirmed allocation was concealed and was marked down in the Pedro score (search.pedro.org.au/search-results/record-detail/41222). |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Data collector blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 29, 21 men Pulmonary rehabilitation group: n = 15, mean age 70 (SD 9) years, mean FVC 77 (SD 16) % predicted, mean TLCO 47 (SD 11) % predicted Control group: n = 14, mean age 72 (SD 8) years, mean FVC 91 (SD 17) % predicted, mean TLCO 55 (SD 14) % predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week tele‐rehabilitation exercise programme consisting of video and chat sessions with a physiotherapist (once weekly for 1 month, once every 2 months for second month and once a month for the remainder of the trial) and home‐based workout sessions with a virtual physiotherapist agent. Workout sessions involved 10–20 minutes of exercise daily using elastics, weights and a fitness step. Control group: usual control programme for people with IPF of outpatient visits approximately once every 3 months | |
| Outcomes | 6MWT King's Brief Interstitial Lung Disease questionnaire SGRQ‐I General Anxiety Disorder Score 7‐day physical activity (steps) Measured before and after intervention period, and at 3‐ and 6‐month follow‐up | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation allocated participants to intervention or control group; performed electronically. |
| Allocation concealment (selection bias) | Unclear risk | Not described. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the physical intervention, it was not possible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Data collector blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | 4 participants in the exercise group and 4 in the control group did not complete the intervention and were not included in the analysis. |
| Selective reporting (reporting bias) | High risk | Not all outcome measures from the clinical trial registry were reported in the abstract. Not all domains for the SGRQ were reported in the results. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial, stratified for IPF, dust‐related ILD and CTD ILD | |
| Participants | ILD: n = 142, including IPF: n = 61, asbestosis: n = 22, CTD ILD: n = 23, 87 men Pulmonary rehabilitation group: n = 74, mean age 69 (SD 11) years, mean FVC 76 (SD 18) % predicted, mean TLCO 50 (SD 16) % predicted Control group: n = 68, mean age 70 (SD 11) years, mean FVC 75 (SD 20) % predicted, mean TLCO 48 (SD 14) % predicted | |
| Interventions | Pulmonary rehabilitation group: 8‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance exercise (cycling and walking). Initial intensity was at 80% of walking speed on initial 6MWT for walking and 70% of peak work rate estimated from the 6MWT for cycling. Exercise training was progressed according to protocol. Upper limb endurance and functional strength training for lower limbs also performed. Supplemental oxygen provided for SpO2 < 85%. Unsupervised home exercise programme prescribed 3 times per week. Group education sessions were offered twice weekly and included understanding lung disease, medications, home oxygen therapy, self‐management, managing breathlessness, exercise and physical activity, stress and anxiety, nutrition, swallowing and airway clearance Control group: weekly telephone calls for general health advice and support | |
| Outcomes | 6MWT Knee extensor and elbow flexor strength via hand‐held dynamometry SGRQ‐I SGRQ UCSD SOBQ HADS mMRC Dyspnoea Scale Measured before and after intervention period and at 6‐month follow‐up | |
| Notes | Supported by Pulmonary Fibrosis Foundation/American Thoracic Society Foundation, Institute for Breathing and Sleep and Eirene Lucas Foundation. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random number sequence. |
| Allocation concealment (selection bias) | Low risk | Sealed opaque envelopes. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Data collector blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis, linear mixed models. |
| Selective reporting (reporting bias) | Low risk | All outcome measures identified in the clinical trials registry (anzctr.org.au) and previously published protocol paper were reported at the same time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 21 Pulmonary rehabilitation group: n = 11, mean age 71 (SD 6) years, mean FVC 60 (SD 11) % predicted, mean TLCO 44 (SD 11) % predicted Control group: n = 11, mean age 66 (SD 7) years, mean FVC 61 (SD 14) % predicted, mean TLCO 43 (SD 11) % predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance training (20 minutes of treadmill walking and 10 minutes of semi‐recumbent cycling) with an initial intensity of 80% HRmax. Strength training for upper and lower limbs using therabands for 15–30 minutes, and flexibility exercise for upper and lower body performed for 15 minutes. Supplemental oxygen was provided to maintain SpO2 > 88%. 10 education lectures were provided including medication use, breathing techniques, exercise training, nutrition, pulmonary physiology and psychological coping mechanisms Control group: no structured exercise. Handouts from education lectures were provided to the control participants | |
| Outcomes | SGRQ‐I IPAQ Dyspnoea (Borg Index) Measured before and after intervention and at 3‐month follow‐up | |
| Notes | Unpublished quality‐of‐life data from study by Jackson 2014, published separately | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Assigned by block randomisation according to random number programme. |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | 3 participants in exercise group and 1 in control group did not complete the intervention period; data were not included in analysis. |
| Selective reporting (reporting bias) | High risk | Borg Dyspnoea Index not reported. Not all domains for SGRQ‐I were reported in the results. Additional data sought from authors. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF n = 30, 17 men Pulmonary rehabilitation group: n = 15, mean age 65 (SD 7) years, mean FVC 65 (SD 11) % predicted, mean TLCO 43 (SD 10) % predicted Control group: n = 15, mean age 65 (SD 8) years, mean FVC 63 (SD 9) % predicted, mean TLCO 43 (SD 10) % predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week outpatient exercise programme, 3–5 days per week consisting of 30–40 minutes of endurance exercise (cycling) Control group: prednisone‐ and azathioprine‐based anti‐inflammatory treatment and symptomatic supportive therapy as necessary | |
| Outcomes | 6MWT ATAQ‐IPF Questionnaire Measured before and after intervention period | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Low risk | All 30 participants' results were included in the analysis. No mention of withdrawals or dropouts. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial Stratified for IPF | |
| Participants | ILD: n = 57, including IPF: n = 34, 31 men Pulmonary rehabilitation group: n = 30, mean age 70 (SD 8) years, mean TLCO 50 (SD 19) % predicted Control group: n = 27, mean age 67 (SD 13) years, mean TLCO 49 (SD 18) % predicted | |
| Interventions | Pulmonary rehabilitation group: 8‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance exercise (cycling and walking) with initial intensity at 80% of walking speed on initial 6MWT and progressed according to protocol. Upper limb endurance and functional strength training for lower limbs also performed. Supplemental oxygen provided for SpO2 < 85%. Unsupervised home exercise programme prescribed 3 times per week Control group: weekly telephone calls for general health advice and support | |
| Outcomes | 6MWT CPET CRQ mMRC Dyspnoea Scale Measured before and after intervention period. 6MWT and questionnaires repeated at 6‐month follow‐up | |
| Notes | Supported by the Victorian Tuberculosis and Lung Association. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random number sequence. |
| Allocation concealment (selection bias) | Low risk | Central location, sealed opaque envelope. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Data collector blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis, last observation carried forward. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 21 Pulmonary rehabilitation group: n = 11, mean age 71 (SD 6) years, mean FVC 60 (SD 11) % predicted, mean TLCO 44 (SD 11) % predicted Control group: n = 10, mean age 66 (SD 7) years, mean FVC 61 (SD 14) % predicted, mean TLCO 43 (SD 11) % predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance training (20 minutes of treadmill walking and 10 minutes of semi‐recumbent cycling) with an initial intensity of 80% HRmax. Strength training for upper and lower limbs using therabands for 15–30 minutes, and flexibility exercise for upper and lower body performed for 15 minutes. Supplemental oxygen provided to maintain SpO2 > 88%. Education component included PowerPoint presentations and handouts for 15 minutes a session (bi‐weekly) Control group: no structured exercise | |
| Outcomes | 6MWT Constant work rate cycle test Treadmill exercise (METs) Maximum inspiratory and expiratory pressures Dyspnoea (Borg Index) F2‐isoprostanes and lactate plasma levels Measured before and after intervention period | |
| Notes | Supported by a Merit Review Award from the Veteran Affairs Research Service. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Low risk | Independent researcher provided group allocation. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | 3 participants in the exercise group and 1 in the control group did not complete the intervention period; data were not included in the analysis. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 545433 Pulmonary rehabilitation group: n = 36, mean age 68 (SD 9) years, mean FVC 74 (SD 19) % predicted, TLCO mean 44 (SD 15) % predicted Control group: n = 18, mean age 65 (SD 10) years, mean FVC 72 (SD 20) % predicted, TLCO mean 37 (SD 19) % predicted | |
| Interventions | Pulmonary rehabilitation group: 3 weeks of inpatient pulmonary rehabilitation, performed 5–6 days per week consisting of endurance or interval cycle training at 60–100% peak work rate on CPET and resistance training for major muscle groups (3 sets of 15–20 repetitions). Psychological support, breathing therapy, education such as disease management, physical activity, nutritional counselling and motivation were also provided Control group: usual care | |
| Outcomes | 6MWT SF‐36 HRQoL Questionnaire CRQ HADS Physical activity (SenseWear Armband) Data measured before and after intervention and at 3‐month follow‐up | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐based randomisation performed with a 1:2 ratio (usual care: pulmonary rehabilitation) using random permutations. |
| Allocation concealment (selection bias) | Low risk | Stated in article on pg 4 that the group allocation sequence was concealed. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | 2 participants in the pulmonary rehabilitation group and 1 in the control group did not complete the study; data were not included in the analysis. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | ILD: n = 40, 16 men Pulmonary rehabilitation group: n = 20, mean age 59 (SD 10) years, mean FVC 52 (SD 14) % predicted Control group: n = 20, mean age 62 (SD 14) years, mean FVC 59 (SD 14) % predicted | |
| Interventions | Pulmonary rehabilitation group: 8‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of endurance exercise (cycling and walking) and strength training. Supplemental oxygen provided to maintain SpO2 > 90% Unsupervised home exercise programme prescribed 2 times per week. Education provided on ILD, drugs used in the treatment, behavioural modification and non‐pharmacological treatment modalities Control group: conventional treatment alone | |
| Outcomes | 6MWT SGRQ mMRC Dyspnoea Scale Measured before and after intervention | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomised by permuted block randomisation. |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | Low risk | All 40 participants completed intervention and all their results were analysed. |
| Selective reporting (reporting bias) | High risk | Incomplete reporting of SGRQ domains and mMRC Dyspnoea Scale. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 24 Pulmonary rehabilitation group: n = 14 Control group: n = 10 | |
| Interventions | Pulmonary rehabilitation group: 3‐month outpatient exercise programme, twice‐weekly supervised sessions consisting of 90 minutes of exercise Control group: maintained its preceding normal physical activity | |
| Outcomes | 6MWT SGRQ Measured before and after intervention | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not specified. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | ILD: n = 22 Mean age 52 (SD 14) years, mean FVC 61 (SD 19) % predicted | |
| Interventions | 12‐week exercise programme, 3 times weekly, supervised sessions of 30–35 minutes each, interval training Pulmonary rehabilitation group: exercised at 60% of maximal power output on cycle ergometer Control group: sham exercise training at minimum workload achievable on cycle ergometer (no resistance) | |
| Outcomes | CRQ 12‐Minute walk test Measured at baseline and 12 weeks | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | Unclear risk | Control group provided with sham training, no details on blinding provided. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not specified. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | ILD: n = 28 | |
| Interventions | Pulmonary rehabilitation group: 8 weeks of supervised pulmonary rehabilitation Control group: standard medical care | |
| Outcomes | 6MWT Mid‐thigh cross‐sectional area on CT TLCO | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | All data on all 28 participants were reported. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | Stage 3 and 4 sarcoidosis: n = 18 Pulmonary rehabilitation group: n = 9, 3 men, mean age 59 years, mean FVC 76% predicted Control group: n = 9, 3 men, mean age 51 years, mean FVC 69% predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of 30 minutes of endurance exercise (cycling and walking). Initial intensity at 80% of walking speed on initial 6MWT and 70% of peak work rate estimated from the 6MWT for cycling. Upper and lower limb strength training also performed. Supplemental oxygen provided for SpO2 < 90%. Unsupervised home exercise programme prescribed. Control group: routine medical treatment | |
| Outcomes | 6MWT SGRQ SF‐36 HRQoL Questionnaire Peripheral muscle force (Quadriceps) mMRC Dyspnoea Scale FSS HADS Measured before and after intervention | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | An individual unrelated to the study performed random allocation to the exercise and usual care groups. |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Low risk | All 18 participants completed intervention and all their results were analysed. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 28 Pulmonary rehabilitation group: n = 13, 12 men, mean age 68 (SD 9) years, mean TLCO 59.4 (SD 16.7) % predicted Control group: n = 15, 9 men, mean age 65 (SD 9) years, mean TLCO 48.6 (SD 16.7) % predicted | |
| Interventions | Pulmonary rehabilitation group: 9‐week outpatient exercise programme, twice‐weekly supervised sessions. Exercise on treadmill at 80% of walking speed on initial 6MWT, or on cycle ergometer at 80% of initial maximum workload. Strength training for limbs using elastic bands for approximately 20 minutes. Supplemental oxygen administered to achieve SpO2 > 90%. Some educational lectures were included (content unspecified) Control group: not specified | |
| Outcomes | 6MWT BDI SGRQ All measured at baseline and 10 weeks | |
| Notes | Supported by the Japanese Ministry of Health, Labor and Welfare. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Low risk | Allocation concealed using sealed envelopes that had been prepared prior to the study. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Low risk | 2 participants randomised to exercise training withdrew before baseline data collected. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | ILD: n = 60 Pulmonary rehabilitation group: n = 30, 22 men, mean age 64 (SD 13) years, mean TLCO 45 (SD 16) % predicted Control group: n = 30, 15 men, mean age 64 (SD 8) years, mean TLCO 41 (SD 13) % predicted | |
| Interventions | Pulmonary rehabilitation group: 6 months of pulmonary rehabilitation with a total of 60 sessions, 3 times a week for first 3 months and twice weekly thereafter. Programme consisted of 90 minutes of exercise training (endurance and strength training) and 30 minutes rotated by session of patient education, occupational therapy, nutrition counselling or psychosocial support. Initial intensity was 75% of walking speed on 6MWT for walking and 60% of peak work rate achieved on CPET for cycling. All participants trained with supplemental oxygen Control group: usual medical care | |
| Outcomes | 6MWT Peak work rate (watts) on CPET SGRQ CRQ Peripheral muscle force (quadriceps) Hand grip muscle force mMRC Dyspnoea Scale Physical activity (SenseWear Armband) Measured before, mid‐way (3 months) and after intervention (6 months), and at 6‐month follow‐up (12 months) | |
| Notes | Abstract in previous review, published as paper in updated review. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients were randomly assigned to the rehabilitation or control group using sealed envelopes prepared and shuffled before the start of the study by an independent person unrelated to the study protocol." (pg 2) |
| Allocation concealment (selection bias) | Low risk | Sealed envelopes. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis, linear mixed modelling. |
| Selective reporting (reporting bias) | Low risk | All outcomes listed in the controlled trial registry (ClinicalTrials.gov) and the paper were reported for all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 31 Pulmonary rehabilitation group: n = 16 Control group: n = 15 | |
| Interventions | Pulmonary rehabilitation group: continuous exercise 3 times week for 3 months Control group: not specified | |
| Outcomes | 6MWT SGRQ | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not specified. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | IPF: n = 32 Pulmonary rehabilitation group: n = 15, mean age 69 (SD 6) years, mean FVC 66 (SD 15) % predicted, mean TLCO 49 (SD 17) % predicted Control group: n = 17, mean age 66 (SD 9) years, mean FVC 70 (SD 17) % predicted, mean TLCO 53 (SD 12) % predicted | |
| Interventions | Pulmonary rehabilitation group: 12‐week outpatient exercise programme, 2 × 6‐week blocks of twice‐weekly 60‐minute supervised sessions. First block consisted of 30 minutes of aerobic interval training with treadmill walking, cycling and step climbing + 10 minutes of strength training; second block consisted of longer periods (20 minutes) of continuous aerobic exercise with resistance training Control group: standard medical care | |
| Outcomes | CPET 6MWT mMRC Dyspnoea Score SGRQ 30‐second chair stand test Pulmonary function Measured before and after intervention and at 11‐month follow‐up | |
| Notes | Abstract in previous review, published as paper in updated review. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was performed by a study coordinator uninvolved in patient assessment or treatment." (pg 379) |
| Allocation concealment (selection bias) | Low risk | Sealed opaque envelopes. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation. |
| Incomplete outcome data (attrition bias) | High risk | 1 participant in the exercise group and 1 in the control group did not complete the intervention period; data were not included in the analysis. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | Sarcoidosis: n = 38 Pulmonary rehabilitation group: n = 20, median age 57.5 (IQR 48–64) years, mean FVC 81 (SD 18) % predicted, mean TLCO 57 (SD 16) % predicted Control group: n = 18, median age 57.5 (IQR 49–65) years, mean FVC 81 (SD 18) % predicted, mean TLCO 63 (SD 19) % predicted | |
| Interventions | Pulmonary rehabilitation group: 2‐month outpatient exercise programme, 3 times a week supervised sessions consisting of an individual‐ and group‐based strengthening exercises, upper/lower limb training and endurance training for minimum of 30 minutes. In addition, participants received therapeutic patient education, psychosocial support and motivational communication to facilitate health‐related behavioural changes and self‐management Control group: oral counselling to increase their physical activity at home | |
| Outcomes | 6‐minute step test mMRC Dyspnoea Score Fatigue Assessment Scale Visual Simplified Respiratory Questionnaire HADS Measured before and after intervention (pulmonary rehabilitation group only), and at 6‐month and 12‐month follow‐up | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated random number sequence. |
| Allocation concealment (selection bias) | Low risk | Sequentially numbered, sealed opaque envelope. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Data collector not blinded to treatment allocation, open label. |
| Incomplete outcome data (attrition bias) | Low risk | Intention‐to‐treat analysis, linear mixed models. |
| Selective reporting (reporting bias) | Low risk | All data available at all time points. |
| Other bias | Low risk | Study appeared free of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | ILD: n = 99 Usual interstitial pneumonia: n = 38; extrinsic allergic alveolitis: n = 8; non‐specific interstitial pneumonia: n = 30; sarcoidosis: n = 23 Pulmonary rehabilitation group: n = 49, mean age 59 years, mean TLCO 49% predicted Control group: n = 50, mean age 62 years, mean TLCO 44% predicted | |
| Interventions | Pulmonary rehabilitation group: 6‐month home‐based walking training, twice‐daily walking for 15 minutes Control group: no scheduled walking | |
| Outcomes | 6MWT CPET Walking distance at home (pedometer) SGRQ Dyspnoea: measure unspecified Measured at baseline and 6 months | |
| Notes | Abstract | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | High risk | Due to the nature of the intervention, it was impossible for participants or personnel to be blinded. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not specified. |
| Selective reporting (reporting bias) | Unclear risk | Abstract only, insufficient details provided. |
| Other bias | Unclear risk | Abstract only, insufficient details provided. |
| Study characteristics | ||
| Methods | Randomised controlled trial | |
| Participants | Pneumoconiosis n = 80, 100% men Pulmonary rehabilitation group: n = 40, mean age 69 (SD 4) years Control group: n = 34, mean age 71 (SD 6) years | |
| Interventions | Pulmonary rehabilitation group: comprehensive rehabilitation treatment with individualised exercise programme for 48 weeks consisting of whole‐body respiratory gymnastics (4 days per week, 15 minutes per day), lung function exercise (4 days per week, 20 minutes per day), upper limb dumbbell exercise (twice a day, 4 days per week), lower limb resistance bicycle exercise (4 days per week, 15 minutes per day) and walking (twice a day, 4 days per week, 15 minutes per day) Control group: routine treatment (oxygen inhalation, atomisation and other common drug therapy) and simple exercise (free movement and hospital‐led gymnastics) | |
| Outcomes | 6MWT SGRQ SF‐36 HRQoL Questionnaire HADS Measured before and after intervention | |
| Notes | There was no information as to whether the comprehensive individualised rehabilitation programme was supervised, or where it was conducted. In addition, participants were encouraged to exercise on their own and could adjust the training intensity and time. Therefore, it was unclear how much of programme was adhered to. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random number table used to randomly divide the pulmonary rehabilitation group and control group. |
| Allocation concealment (selection bias) | Unclear risk | Not specified. |
| Blinding of participants and personnel (performance bias) | Unclear risk | Control group received hospital‐led gymnastics and simple exercise; therefore, possible participants could be blinded although study did not specify. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not specified. |
| Incomplete outcome data (attrition bias) | High risk | 6 participants in the control group were lost to follow‐up; these data were not included in the analysis. |
| Selective reporting (reporting bias) | High risk | Data for HADS not reported. |
| Other bias | Unclear risk | Hospital‐led respiratory gymnastics was supervised for entire 48 weeks. In addition, it appeared this was the case for both the control and intervention groups. There was no information whether the comprehensive individualised rehabilitation programme was supervised, or where it was conducted. Participants were encouraged to exercise on their own and they could adjust the training intensity and time according to their own conditions while ensuring their own safety implying a home‐based model. This suggests the programme could have been quite varied across the individuals. |
6MWT: six‐minute walk test; ATAQ‐IPF: A Tool to Assess Quality of life in IPF; BDI: Baseline Dyspnoea Index; CPET: Cardiopulmonary Exercise Test; CRQ: Chronic Respiratory Disease Questionnaire; CT: computed tomography; CTD: connective tissue disease; FSS: Fatigue Severity Scale; FVC: forced vital capacity; HRQoL: health‐related quality of life; HADS: Hospital Anxiety and Depression Scale; HRmax: maximum heart rate; ILD: interstitial lung disease; IPAQ: International Physical Activity Questionnaire; IPF: idiopathic pulmonary fibrosis; IQR: interquartile range; METs: metabolic equivalents; mMRC: Modified Medical Research Council Dyspnoea Scale; n: number of participants; SD: standard deviation; SF‐36: 36‐item Short Form; SGRQ: St George's Respiratory Questionnaire; SGRQ‐I: SGRQ‐I; St George's Respiratory Questionnaire IPF version; SpO2: oxyhaemoglobin saturation; TLCO: transfer factor for carbon monoxide; UCSD SOBQ: University of California San Diego Shortness of Breath Questionnaire; WHO: World Health Organization.
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Not a randomised controlled trial. | |
| Mixed disease group: participants had chronic obstructive pulmonary disease and coal worker's pneumoconiosis. | |
| Mixed disease group: participants had chronic obstructive pulmonary disease and coal worker's pneumoconiosis. | |
| Participants did not have ILD. | |
| ILD represented 5% of total cohort, Intervention too short. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Rehabilitation programme did not qualify as pulmonary rehabilitation. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| No control group, compared 2 difference exercise training protocols. | |
| Mixed disease group: diagnoses not reported. | |
| Not a randomised controlled trial. | |
| Not a randomised controlled trial. | |
| Participants did not have ILD. | |
| Participants did not have ILD. | |
| Efficacy of training modality not an intervention. | |
| Participants did not undergo pulmonary rehabilitation. | |
| Rehabilitation programme did not qualify as pulmonary rehabilitation. |
ILD: interstitial lung disease.
Characteristics of studies awaiting classification [ordered by study ID]
| Methods | Randomised controlled trial |
| Participants | ILD: n = 62 (50 completed study and were included in analysis) (50 completed study and were included in analysis), 18 men Pulmonary rehabilitation group: n = 25, mean age 47 (SD 13) years, mean FVC 57 (SD 2) % predicted Control group: n = 25, mean age 49 (SD 10) years, mean FVC 57 (SD 2) % predicted |
| Interventions | Pulmonary rehabilitation group: 8‐week outpatient exercise programme, twice‐weekly supervised sessions consisting of endurance interval exercise (cycling), with 30–180 seconds of exercise and equivalent rest intervals. Initial intensity was at 80–100% maximum heart rate. Duration was 15–20 minutes increasing to 45–60 minutes. Resistance training (2–4 sets of 6–12 repetitions) was also performed. Supplemental oxygen provided for SpO2 < 85%. Unsupervised home exercise programme prescribed 3 times per week. The pulmonary rehabilitation programme included patient health education Control group: received conventional pharmacological therapy for ILD |
| Outcomes | 6MWT SF‐36 HRQoL Questionnaire mMRC Dyspnoea Scale Measured before and after intervention period and at 6‐month follow‐up |
| Notes | Accuracy of data unclear |
6MWT: six‐minute walk test; FVC: forced vital capacity; HRQoL: health‐related quality of life; ILD: interstitial lung disease; mMRC: Modified Medical Research Council Dyspnoea Scale; SD: standard deviation; SF‐36: 36‐item Short Form; SpO2: oxygen saturation.
Characteristics of ongoing studies [ordered by study ID]
| Study name | Long‐term effect of pulmonary rehabilitation under nintedanib treatment in idiopathic pulmonary fibrosis |
| Methods | Randomised controlled trial |
| Participants | 80 participants with IPF |
| Interventions | Pulmonary rehabilitation group: short‐term pulmonary rehabilitation programme (8 weeks of twice weekly aerobic cycle exercise training) followed by maintenance pulmonary rehabilitation programme (44 weeks of once weekly aerobic cycle exercise training) Control group: no pulmonary rehabilitation |
| Outcomes | 6MWT SGRQ Dyspnoea‐12 Questionnaire TDI CAT Physical activity (triaxial accelerometer) Pulmonary function Rate of mortality and hospitalisation Measured before and at 12‐month follow‐up |
| Starting date | September 2017 |
| Contact information | Ryo Kozu, Email: ryokozu@nagasaki‐u.ac.jp |
| Notes | upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030312 |
6MWT: six‐minute walk distance; CAT: COPD Assessment Test; IPF: idiopathic pulmonary fibrosis; SGRQ: St George's respiratory questionnaire; TDI: Transition Dyspnoea Index.
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Change in 6‐minute walk distance immediately following pulmonary rehabilitation. Mean change from baseline, metres Show forest plot | 13 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.1  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 1: Change in 6‐minute walk distance immediately following pulmonary rehabilitation. Mean change from baseline, metres | ||||
| 1.1.1 All participants | 13 | 585 | Mean Difference (IV, Fixed, 95% CI) | 40.07 [32.70, 47.44] |
| 1.1.2 Idiopathic pulmonary fibrosis only | 8 | 278 | Mean Difference (IV, Fixed, 95% CI) | 37.25 [26.16, 48.33] |
| 1.1.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 15.37 [‐10.70, 41.43] |
| 1.1.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 20.12 [‐2.62, 42.87] |
| 1.2 Change in 6‐minute walk test at long‐term follow‐up. Mean change from baseline, metres Show forest plot | 5 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.2  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 2: Change in 6‐minute walk test at long‐term follow‐up. Mean change from baseline, metres | ||||
| 1.2.1 All participants | 5 | 297 | Mean Difference (IV, Fixed, 95% CI) | 32.43 [15.58, 49.28] |
| 1.2.2 Idiopathic pulmonary fibrosis only | 3 | 123 | Mean Difference (IV, Fixed, 95% CI) | 1.64 [‐24.89, 28.17] |
| 1.2.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 4.20 [‐28.99, 37.40] |
| 1.2.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 1.76 [‐28.95, 32.47] |
| 1.3 Change in peak work rate immediately following pulmonary rehabilitation, watts Show forest plot | 4 | 274 | Mean Difference (IV, Fixed, 95% CI) | 7.55 [5.66, 9.44] |
| Analysis 1.3  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 3: Change in peak work rate immediately following pulmonary rehabilitation, watts | ||||
| 1.3.1 All participants | 4 | 159 | Mean Difference (IV, Fixed, 95% CI) | 9.04 [6.07, 12.00] |
| 1.3.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 9.94 [6.39, 13.49] |
| 1.3.3 Severe lung disease | 1 | 23 | Mean Difference (IV, Fixed, 95% CI) | 2.10 [‐2.29, 6.49] |
| 1.3.4 Desaturators | 1 | 30 | Mean Difference (IV, Fixed, 95% CI) | 5.40 [0.07, 10.73] |
| 1.4 Change in VO 2 peak immediately following pulmonary rehabilitation, mL/kg/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.4  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 4: Change in VO 2 peak immediately following pulmonary rehabilitation, mL/kg/minute | ||||
| 1.4.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | 1.28 [0.51, 2.05] |
| 1.4.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 1.45 [0.51, 2.40] |
| 1.4.3 Severe lung disease | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐0.03 [‐1.36, 1.30] |
| 1.4.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | 0.84 [‐0.31, 1.99] |
| 1.5 Change in maximum ventilation (Ve max ) immediately following pulmonary rehabilitation, L/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.5  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 5: Change in maximum ventilation (Ve max ) immediately following pulmonary rehabilitation, L/minute | ||||
| 1.5.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | 7.21 [4.10, 10.32] |
| 1.5.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 9.80 [6.06, 13.53] |
| 1.5.3 Severe lung disease | 1 | 20 | Mean Difference (IV, Fixed, 95% CI) | 4.16 [‐3.34, 11.66] |
| 1.5.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | 6.95 [0.03, 13.87] |
| 1.6 Change in maximum heart rate immediately following pulmonary rehabilitation, beats/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.6  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 6: Change in maximum heart rate immediately following pulmonary rehabilitation, beats/minute | ||||
| 1.6.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | ‐0.77 [‐4.25, 2.72] |
| 1.6.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | ‐0.38 [‐3.78, 3.01] |
| 1.6.3 Severe lung disease | 1 | 20 | Mean Difference (IV, Fixed, 95% CI) | ‐5.38 [‐11.46, 0.70] |
| 1.6.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐0.45 [‐6.07, 5.17] |
| 1.7 Change in dyspnoea score immediately following pulmonary rehabilitation Show forest plot | 7 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.7  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 7: Change in dyspnoea score immediately following pulmonary rehabilitation | ||||
| 1.7.1 All participants | 7 | 348 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.36 [‐0.58, ‐0.14] |
| 1.7.2 Idiopathic pulmonary fibrosis only | 4 | 155 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.41 [‐0.74, ‐0.09] |
| 1.7.3 Severe lung disease | 2 | 84 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.25 [‐0.68, 0.19] |
| 1.7.4 Desaturators | 2 | 103 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.39 [‐0.79, 0.00] |
| 1.8 Change in dyspnoea score at long‐term follow‐up Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.8  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 8: Change in dyspnoea score at long‐term follow‐up | ||||
| 1.8.1 All participants | 6 | 335 | Mean Difference (IV, Fixed, 95% CI) | ‐0.29 [‐0.49, ‐0.10] |
| 1.8.2 Idiopathic pulmonary fibrosis only | 3 | 123 | Mean Difference (IV, Fixed, 95% CI) | ‐0.38 [‐0.72, ‐0.05] |
| 1.8.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.14 [‐0.36, 0.63] |
| 1.8.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.03 [‐0.42, 0.35] |
| 1.9 Change in quality of life (St George's Respiratory Questionnaire (SGRQ) Symptoms) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐13.68 [‐16.59, ‐10.77] |
| Analysis 1.9  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 9: Change in quality of life (St George's Respiratory Questionnaire (SGRQ) Symptoms) immediately following pulmonary rehabilitation | ||||
| 1.9.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐15.58 [‐19.54, ‐11.62] |
| 1.9.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐13.92 [‐19.68, ‐8.17] |
| 1.9.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐9.20 [‐19.17, 0.77] |
| 1.9.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐7.70 [‐16.17, 0.77] |
| 1.10 Change in quality of life (SGRQ Activity) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐2.30 [‐3.46, ‐1.14] |
| Analysis 1.10  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 10: Change in quality of life (SGRQ Activity) immediately following pulmonary rehabilitation | ||||
| 1.10.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐2.47 [‐4.11, ‐0.83] |
| 1.10.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐1.71 [‐3.44, 0.01] |
| 1.10.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐3.60 [‐11.51, 4.31] |
| 1.10.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐8.20 [‐15.55, ‐0.85] |
| 1.11 Change in quality of life (SGRQ Impact) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐8.66 [‐10.37, ‐6.94] |
| Analysis 1.11  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 11: Change in quality of life (SGRQ Impact) immediately following pulmonary rehabilitation | ||||
| 1.11.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐8.81 [‐11.17, ‐6.46] |
| 1.11.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐8.94 [‐11.76, ‐6.13] |
| 1.11.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐8.00 [‐16.18, 0.18] |
| 1.11.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐5.90 [‐12.99, 1.19] |
| 1.12 Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation Show forest plot | 11 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.12  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 12: Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation | ||||
| 1.12.1 All participants | 11 | 478 | Mean Difference (IV, Fixed, 95% CI) | ‐9.29 [‐11.06, ‐7.52] |
| 1.12.2 Idiopathic pulmonary fibrosis only | 6 | 194 | Mean Difference (IV, Fixed, 95% CI) | ‐7.91 [‐10.55, ‐5.26] |
| 1.12.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐6.40 [‐12.79, ‐0.01] |
| 1.12.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐6.00 [‐11.56, ‐0.44] |
| 1.13 Change in quality of life (SGRQ Symptoms) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐9.14 [‐12.91, ‐5.37] |
| Analysis 1.13  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 13: Change in quality of life (SGRQ Symptoms) at long‐term follow‐up | ||||
| 1.13.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐11.31 [‐16.58, ‐6.03] |
| 1.13.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐6.84 [‐15.77, 2.10] |
| 1.13.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐12.00 [‐22.41, ‐1.59] |
| 1.13.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐3.20 [‐12.08, 5.68] |
| 1.14 Change in quality of life (SGRQ Activity) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐1.41 [‐2.51, ‐0.30] |
| Analysis 1.14  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 14: Change in quality of life (SGRQ Activity) at long‐term follow‐up | ||||
| 1.14.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐1.54 [‐3.11, 0.02] |
| 1.14.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐1.07 [‐2.70, 0.56] |
| 1.14.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐1.80 [‐9.93, 6.33] |
| 1.14.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐5.20 [‐12.82, 2.42] |
| 1.15 Change in quality of life (SGRQ Impact) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐3.57 [‐5.79, ‐1.35] |
| Analysis 1.15  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 15: Change in quality of life (SGRQ Impact) at long‐term follow‐up | ||||
| 1.15.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐4.73 [‐7.76, ‐1.69] |
| 1.15.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐4.59 [‐8.60, ‐0.57] |
| 1.15.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | 1.40 [‐7.05, 9.85] |
| 1.15.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | 2.90 [‐4.45, 10.25] |
| 1.16 Change in quality of life (SGRQ Total) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐3.60 [‐5.66, ‐1.55] |
| Analysis 1.16  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 16: Change in quality of life (SGRQ Total) at long‐term follow‐up | ||||
| 1.16.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐4.93 [‐7.81, ‐2.06] |
| 1.16.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐3.45 [‐7.43, 0.52] |
| 1.16.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐1.90 [‐8.57, 4.77] |
| 1.16.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐5.62, 5.82] |
| 1.17 Change in quality of life (Chronic Respiratory Disease Questionnaire (CRQ) Dyspnoea) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.72 [0.55, 0.88] |
| Analysis 1.17  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 17: Change in quality of life (Chronic Respiratory Disease Questionnaire (CRQ) Dyspnoea) immediately following pulmonary rehabilitation | ||||
| 1.17.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.68 [0.42, 0.93] |
| 1.17.2 Idiopathic pulmona ry fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.81 [0.49, 1.14] |
| 1.17.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.68 [0.21, 1.15] |
| 1.17.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.69 [0.30, 1.08] |
| 1.18 Change in quality of life (CRQ Fatigue) immediately following pulmonary rehabilitation. Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.66 [0.49, 0.82] |
| Analysis 1.18  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 18: Change in quality of life (CRQ Fatigue) immediately following pulmonary rehabilitation. | ||||
| 1.18.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.66 [0.43, 0.90] |
| 1.18.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.67 [0.36, 0.98] |
| 1.18.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.65 [0.17, 1.13] |
| 1.18.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.60 [0.15, 1.06] |
| 1.19 Change in quality of life (CRQ Emotion) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.55 [0.40, 0.70] |
| Analysis 1.19  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 19: Change in quality of life (CRQ Emotion) immediately following pulmonary rehabilitation | ||||
| 1.19.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.63 [0.42, 0.84] |
| 1.19.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.64 [0.33, 0.95] |
| 1.19.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.30 [‐0.15, 0.75] |
| 1.19.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.30 [‐0.09, 0.70] |
| 1.20 Change in quality of life (CRQ Mastery) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.62 [0.46, 0.79] |
| Analysis 1.20  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 20: Change in quality of life (CRQ Mastery) immediately following pulmonary rehabilitation | ||||
| 1.20.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.67 [0.44, 0.90] |
| 1.20.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.63 [0.33, 0.94] |
| 1.20.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.52 [‐0.04, 1.07] |
| 1.20.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.49 [0.02, 0.96] |
| 1.21 Change in quality of life (CRQ Dyspnoea) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.25 [0.07, 0.44] |
| Analysis 1.21  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 21: Change in quality of life (CRQ Dyspnoea) at long‐term follow‐up | ||||
| 1.21.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.42 [0.17, 0.68] |
| 1.21.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.26, 0.72] |
| 1.21.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.08 [‐0.42, 0.58] |
| 1.21.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.10 [‐0.54, 0.34] |
| 1.22 Change in quality of life (CRQ Fatigue) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.26 [0.05, 0.48] |
| Analysis 1.22  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 22: Change in quality of life (CRQ Fatigue) at long‐term follow‐up | ||||
| 1.22.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.40 [0.09, 0.70] |
| 1.22.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.31 [‐0.20, 0.83] |
| 1.22.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.37, 0.69] |
| 1.22.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.04 [‐0.54, 0.46] |
| 1.23 Change in quality of life (CRQ Emotion) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.32 [0.13, 0.50] |
| Analysis 1.23  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 23: Change in quality of life (CRQ Emotion) at long‐term follow‐up | ||||
| 1.23.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.51 [0.26, 0.77] |
| 1.23.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.23, 0.70] |
| 1.23.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.29, 0.61] |
| 1.23.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.00 [‐0.42, 0.42] |
| 1.24 Change in quality of life (CRQ Mastery) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.27 [0.05, 0.50] |
| Analysis 1.24  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 24: Change in quality of life (CRQ Mastery) at long‐term follow‐up | ||||
| 1.24.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.47 [0.17, 0.78] |
| 1.24.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.47, 0.67] |
| 1.24.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.37, 0.83] |
| 1.24.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.15 [‐0.68, 0.38] |
| 1.25 Long‐term survival Show forest plot | 4 | Odds Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| Analysis 1.25  Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 25: Long‐term survival | ||||
| 1.25.1 All participants | 4 | 291 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.14, 1.12] |
| 1.25.2 Idiopathic pulmonary fibrosis only | 3 | 127 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.08, 1.19] |
| 1.25.3 Severe lung disease | 2 | 84 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.14, 2.05] |
| 1.25.4 Desaturators | 2 | 103 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.15, 2.35] |
Study flow diagram for 2014–2020 literature searches. HRQoL: health‐related quality of life.
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Forest plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.1 Change in six‐minute walk test immediately following pulmonary rehabilitation.
Funnel plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.1 Change in six‐minute walk distance immediately following pulmonary rehabilitation. Mean change from baseline, metres.
Forest plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.3 Change in peak work rate immediately following pulmonary rehabilitation, watts.
Forest plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.6 Dyspnoea score immediately following pulmonary rehabilitation.
Forest plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.12 Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation.
Funnel plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.12 Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation.
Forest plot of comparison: 1 Pulmonary rehabilitation versus no pulmonary rehabilitation, outcome: 1.17 Change in quality of life (Chronic Respiratory Disease Questionnaire (CRQ) Dyspnoea) immediately following pulmonary rehabilitation.
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 1: Change in 6‐minute walk distance immediately following pulmonary rehabilitation. Mean change from baseline, metres
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 2: Change in 6‐minute walk test at long‐term follow‐up. Mean change from baseline, metres
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 3: Change in peak work rate immediately following pulmonary rehabilitation, watts
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 4: Change in VO 2 peak immediately following pulmonary rehabilitation, mL/kg/minute
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 5: Change in maximum ventilation (Ve max ) immediately following pulmonary rehabilitation, L/minute
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 6: Change in maximum heart rate immediately following pulmonary rehabilitation, beats/minute
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 7: Change in dyspnoea score immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 8: Change in dyspnoea score at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 9: Change in quality of life (St George's Respiratory Questionnaire (SGRQ) Symptoms) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 10: Change in quality of life (SGRQ Activity) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 11: Change in quality of life (SGRQ Impact) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 12: Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 13: Change in quality of life (SGRQ Symptoms) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 14: Change in quality of life (SGRQ Activity) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 15: Change in quality of life (SGRQ Impact) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 16: Change in quality of life (SGRQ Total) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 17: Change in quality of life (Chronic Respiratory Disease Questionnaire (CRQ) Dyspnoea) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 18: Change in quality of life (CRQ Fatigue) immediately following pulmonary rehabilitation.
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 19: Change in quality of life (CRQ Emotion) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 20: Change in quality of life (CRQ Mastery) immediately following pulmonary rehabilitation
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 21: Change in quality of life (CRQ Dyspnoea) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 22: Change in quality of life (CRQ Fatigue) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 23: Change in quality of life (CRQ Emotion) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 24: Change in quality of life (CRQ Mastery) at long‐term follow‐up
Comparison 1: Pulmonary rehabilitation versus no pulmonary rehabilitation, Outcome 25: Long‐term survival
| Pulmonary rehabilitation compared to no pulmonary rehabilitation for interstitial lung disease | ||||||
| Patient or population: interstitial lung disease | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no pulmonary rehabilitation | Risk with pulmonary rehabilitation | |||||
| Change in 6MWD | The mean change in 6MWD ranged from –35 metres to 26 metres | MD 40.07 metres higher | — | 585 | ⊕⊕⊕⊝ | Sensitivity analysis from studies at lower risk of bias was similar (MD 41.22 metres, 95% CI 26.80 to 55.64; 5 RCTs, 288 participants; I² = 35%). |
| Change in 6MWD at long‐term follow‐up | The mean change in 6MWD at long‐term follow‐up ranged from –49 metres to –6 metres | MD 32.43 metres higher | — | 321 | ⊕⊕⊕⊝ | — |
| Change in peak work capacity | The mean change in peak work capacity ranged from –10 watts to 0.6 watts | MD 9.04 watts higher | — | 159 | ⊕⊕⊝⊝ | — |
| Change in dyspnoea score | The mean change in dyspnoea score ranged from –0.2 to 0.4 | SMD 0.36 SD lower | — | 348 | ⊕⊕⊝⊝ | Lower value post intervention is favourable, indicating improvement in dyspnoea. Sensitivity analysis from studies at lower risk of bias was similar (SMD –0.28, 95% CI –0.51 to –0.04; 5 RCTs, 288 participants; I² = 70%). SMD of –0.36 corresponds to MD of –0.32 points when re‐expressed on the modified Medical Research Dyspnoea Scale (0–4, 5‐point score, 0 indicates no dyspnoea). |
| Change in quality of life | The mean change in quality of life ranged from –7 to 6 points | MD 9.29 points lower | — | 478 | ⊕⊕⊕⊝ | Lower value post intervention is favourable, indicating improvement in quality of life. Sensitivity analysis from studies at lower risk of bias was similar (MD –8.13, 95% CI –11.24 to –5.02; 4 RCTs, 231 participants; I² = 21%). |
| Change in quality of life at long‐term | The mean change in quality of life at long‐term follow‐up ranged from –1 to 5 points | MD 4.93 points lower | — | 240 | ⊕⊕⊝⊝ | Lower value post intervention is favourable, indicating improvement in quality of life. |
| Long‐term survival (incidence of mortality) | Study population | OR 0.40 | 291 | ⊕⊕⊝⊝ | Lower OR represents improved survival at long‐term follow‐up. | |
| 85 per 1000 | 36 per 1000 | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 6MWD: 6‐minute walk distance; 6MWT: 6‐minute walk test; CI: confidence interval; MD: mean difference; OR: odds ratio; RCT: randomised controlled trial; SD: standard deviation; SGRQ: St George's Respiratory Questionnaire; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for detection bias (nine to 11 studies), attrition bias (five to eight studies) and selection bias (seven studies). | ||||||
| Pulmonary rehabilitation compared to no pulmonary rehabilitation for idiopathic pulmonary fibrosis | ||||||
| Patient or population: idiopathic pulmonary fibrosis | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no pulmonary rehabilitation | Risk with pulmonary rehabilitation | |||||
| Change in 6MWD | The mean change in 6MWD ranged from –35 metres to 26 metres | MD 37.25 metres higher | — | 278 | ⊕⊕⊕⊝ | — |
| Change in 6MWD at long‐term follow‐up | The mean change in 6MWD at long‐term follow‐up ranged from –49 metres to 4 metres | MD 1.64 metres higher | — | 123 | ⊕⊕⊝⊝ | — |
| Change in peak work capacity | The mean change in peak work capacity ranged from –7 watts to –0.8 watts | MD 9.94 watts higher | — | 62 | ⊕⊕⊝⊝ | — |
| Change in dyspnoea score | The mean change in dyspnoea score ranged from –0.06 to 0.4 | SMD 0.41 lower | — | 155 | ⊕⊕⊝⊝ | Lower value post intervention is favourable, indicating improvement in dyspnoea. SMD of –0.41 corresponds to MD of –0.37 points when re‐expressed on the modified Medical Research Dyspnoea Scale (0–4, 5‐point score, 0 indicates no dyspnoea). |
| Change in quality of life | The mean change in quality of life ranged from –3 to 3 points | MD 7.91 points lower | — | 194 | ⊕⊕⊕⊝ | Lower value post intervention is favourable, indicating improvement in quality of life. |
| Change in quality of life at long‐term | The mean change in quality of life at long‐term follow‐up ranged from 1 to 4 points | MD 3.45 points lower | — | 89 | ⊕⊕⊝⊝ | Lower value post intervention is favourable, indicating improvement in quality of life. |
| Long‐term survival (incidence of mortality) | Study population | OR 0.32 | 127 | ⊕⊕⊝⊝ | Lower OR represents improved survival at long‐term follow‐up. | |
| 133 per 1000 | 47 per 1000 | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 6MWD: 6‐minute walk distance; 6MWT: 6‐minute walk test; CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial; SGRQ: St George's Respiratory Questionnaire. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for detection bias (four or five studies), attrition bias (three or four studies) and selection bias (five studies) | ||||||
| Study | Follow‐up | Duration (weeks) | Sessions (per week) | Setting | Programme type |
|---|---|---|---|---|---|
| 5 weeks | 5 | 5 | Outpatient | Exercise + other | |
| 8, 26 weeks | 8 | 2 | Outpatient | Exercise | |
| 12 weeks | 12 | 5–7 | Tele‐rehabilitation | Exercise | |
| 8 weeks, 6 months | 8 | 2 | Outpatient | Exercise + other | |
| 12 weeks, 3 months | 12 | 2 | Outpatient | Exercise + other | |
| 12 weeks | 12 | 3–5 | Outpatient | Exercise | |
| 8, 26 weeks | 8 | 2 | Outpatient | Exercise | |
| 12 weeks, 3 months | 12 | 2 | Outpatient | Exercise + other | |
| 3 weeks, 3 months | 3 | 5–6 | Inpatient | Exercise + other | |
| 8 weeks | 8 | 2 | Outpatient | Exercise + other | |
| 12 weeks | 12 | 2 | Outpatient | Exercise | |
| 12 weeks | 12 | 3 | Outpatient | Exercise | |
| 8 weeks | 8 | — | Outpatient | Exercise | |
| 12 weeks | 12 | 2 | Outpatient | Exercise | |
| 9 weeks | 9 | 2 | Outpatient | Exercise | |
| 3, 6, 12 months | 26 | 2–3 | Outpatient | Exercise + other | |
| 12 weeks | 12 | 3 | Outpatient | Exercise | |
| 12 weeks | 12 | 2 | Outpatient | Exercise | |
| 8 weeks | 8 | 3 | Outpatient | Exercise + other | |
| 6 months | 26 | 7 | Home | Exercise | |
| 48 weeks | 48 | 4 | Outpatient/home | Exercise + other |
| Outcome | Subscale | Included studies | № of participants | Heterogeneity | MD (95% CI) | Test of overall effect |
|---|---|---|---|---|---|---|
| 6MWT | — | Dale 2014; Dowman 2017; Holland 2008; Naz 2018; Perez Bogerd 2018 | 288 | I² = 35%, P = 0.19 | 41.22 metres (26.80 to 55.64) | P < 0.00001 |
| Dyspnoea score | — | 288 | I² = 70%, P = 0.01 | –0.28 (–0.51 to –0.04) | P < 0.02 | |
| SGRQ | Symptoms | 231 | I² = 51%, P = 0.11 | –13.76 (–18.49 to –9.04) | P < 0.00001 | |
| Activity | 231 | I² = 21%, P = 0.28 | –8.56 (–12.90 to –4.22) | P = 0.0001 | ||
| Impact | 231 | I² = 0%, P = 0.83 | –7.91 (–11.54 to –4.29) | P < 0.0001 | ||
| Total | 231 | I² = 21%, P = 0.29 | –8.13 (–11.24 to –5.02) | P < 0.00001 | ||
| CRQ | Dyspnoea | 270 | I² = 41%, P = 0.18 | 0.61 (0.32 to 0.90) | P < 0.0001 | |
| Fatigue | 270 | I² = 0%, P = 0.93 | 0.66 (0.40 to 0.92) | P < 0.00001 | ||
| Emotion | 270 | I² = 0%, P = 0.44 | 0.58 (0.35 to 0.81) | P < 0.00001 | ||
| Mastery | 270 | I² = 58%, P = 0.07 | 0.71 (0.44 to 0.98) | P < 0.00001 | ||
| 6MWT: six‐minute walk test; CI: confidence interval; CRQ: Chronic Respiratory Disease Questionnaire; MD: mean difference; SGRQ: St George's Respiratory Questionnaire. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Change in 6‐minute walk distance immediately following pulmonary rehabilitation. Mean change from baseline, metres Show forest plot | 13 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1.1 All participants | 13 | 585 | Mean Difference (IV, Fixed, 95% CI) | 40.07 [32.70, 47.44] |
| 1.1.2 Idiopathic pulmonary fibrosis only | 8 | 278 | Mean Difference (IV, Fixed, 95% CI) | 37.25 [26.16, 48.33] |
| 1.1.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 15.37 [‐10.70, 41.43] |
| 1.1.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 20.12 [‐2.62, 42.87] |
| 1.2 Change in 6‐minute walk test at long‐term follow‐up. Mean change from baseline, metres Show forest plot | 5 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.2.1 All participants | 5 | 297 | Mean Difference (IV, Fixed, 95% CI) | 32.43 [15.58, 49.28] |
| 1.2.2 Idiopathic pulmonary fibrosis only | 3 | 123 | Mean Difference (IV, Fixed, 95% CI) | 1.64 [‐24.89, 28.17] |
| 1.2.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 4.20 [‐28.99, 37.40] |
| 1.2.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 1.76 [‐28.95, 32.47] |
| 1.3 Change in peak work rate immediately following pulmonary rehabilitation, watts Show forest plot | 4 | 274 | Mean Difference (IV, Fixed, 95% CI) | 7.55 [5.66, 9.44] |
| 1.3.1 All participants | 4 | 159 | Mean Difference (IV, Fixed, 95% CI) | 9.04 [6.07, 12.00] |
| 1.3.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 9.94 [6.39, 13.49] |
| 1.3.3 Severe lung disease | 1 | 23 | Mean Difference (IV, Fixed, 95% CI) | 2.10 [‐2.29, 6.49] |
| 1.3.4 Desaturators | 1 | 30 | Mean Difference (IV, Fixed, 95% CI) | 5.40 [0.07, 10.73] |
| 1.4 Change in VO 2 peak immediately following pulmonary rehabilitation, mL/kg/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.4.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | 1.28 [0.51, 2.05] |
| 1.4.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 1.45 [0.51, 2.40] |
| 1.4.3 Severe lung disease | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐0.03 [‐1.36, 1.30] |
| 1.4.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | 0.84 [‐0.31, 1.99] |
| 1.5 Change in maximum ventilation (Ve max ) immediately following pulmonary rehabilitation, L/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.5.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | 7.21 [4.10, 10.32] |
| 1.5.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | 9.80 [6.06, 13.53] |
| 1.5.3 Severe lung disease | 1 | 20 | Mean Difference (IV, Fixed, 95% CI) | 4.16 [‐3.34, 11.66] |
| 1.5.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | 6.95 [0.03, 13.87] |
| 1.6 Change in maximum heart rate immediately following pulmonary rehabilitation, beats/minute Show forest plot | 3 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.6.1 All participants | 3 | 94 | Mean Difference (IV, Fixed, 95% CI) | ‐0.77 [‐4.25, 2.72] |
| 1.6.2 Idiopathic pulmonary fibrosis only | 2 | 62 | Mean Difference (IV, Fixed, 95% CI) | ‐0.38 [‐3.78, 3.01] |
| 1.6.3 Severe lung disease | 1 | 20 | Mean Difference (IV, Fixed, 95% CI) | ‐5.38 [‐11.46, 0.70] |
| 1.6.4 Desaturators | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐0.45 [‐6.07, 5.17] |
| 1.7 Change in dyspnoea score immediately following pulmonary rehabilitation Show forest plot | 7 | Std. Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.7.1 All participants | 7 | 348 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.36 [‐0.58, ‐0.14] |
| 1.7.2 Idiopathic pulmonary fibrosis only | 4 | 155 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.41 [‐0.74, ‐0.09] |
| 1.7.3 Severe lung disease | 2 | 84 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.25 [‐0.68, 0.19] |
| 1.7.4 Desaturators | 2 | 103 | Std. Mean Difference (IV, Fixed, 95% CI) | ‐0.39 [‐0.79, 0.00] |
| 1.8 Change in dyspnoea score at long‐term follow‐up Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.8.1 All participants | 6 | 335 | Mean Difference (IV, Fixed, 95% CI) | ‐0.29 [‐0.49, ‐0.10] |
| 1.8.2 Idiopathic pulmonary fibrosis only | 3 | 123 | Mean Difference (IV, Fixed, 95% CI) | ‐0.38 [‐0.72, ‐0.05] |
| 1.8.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.14 [‐0.36, 0.63] |
| 1.8.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.03 [‐0.42, 0.35] |
| 1.9 Change in quality of life (St George's Respiratory Questionnaire (SGRQ) Symptoms) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐13.68 [‐16.59, ‐10.77] |
| 1.9.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐15.58 [‐19.54, ‐11.62] |
| 1.9.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐13.92 [‐19.68, ‐8.17] |
| 1.9.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐9.20 [‐19.17, 0.77] |
| 1.9.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐7.70 [‐16.17, 0.77] |
| 1.10 Change in quality of life (SGRQ Activity) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐2.30 [‐3.46, ‐1.14] |
| 1.10.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐2.47 [‐4.11, ‐0.83] |
| 1.10.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐1.71 [‐3.44, 0.01] |
| 1.10.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐3.60 [‐11.51, 4.31] |
| 1.10.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐8.20 [‐15.55, ‐0.85] |
| 1.11 Change in quality of life (SGRQ Impact) immediately following pulmonary rehabilitation Show forest plot | 7 | 588 | Mean Difference (IV, Fixed, 95% CI) | ‐8.66 [‐10.37, ‐6.94] |
| 1.11.1 All participants | 7 | 312 | Mean Difference (IV, Fixed, 95% CI) | ‐8.81 [‐11.17, ‐6.46] |
| 1.11.2 Idiopathic pulmonary fibrosis only | 4 | 142 | Mean Difference (IV, Fixed, 95% CI) | ‐8.94 [‐11.76, ‐6.13] |
| 1.11.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐8.00 [‐16.18, 0.18] |
| 1.11.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐5.90 [‐12.99, 1.19] |
| 1.12 Change in quality of life (SGRQ Total) immediately following pulmonary rehabilitation Show forest plot | 11 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.12.1 All participants | 11 | 478 | Mean Difference (IV, Fixed, 95% CI) | ‐9.29 [‐11.06, ‐7.52] |
| 1.12.2 Idiopathic pulmonary fibrosis only | 6 | 194 | Mean Difference (IV, Fixed, 95% CI) | ‐7.91 [‐10.55, ‐5.26] |
| 1.12.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐6.40 [‐12.79, ‐0.01] |
| 1.12.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐6.00 [‐11.56, ‐0.44] |
| 1.13 Change in quality of life (SGRQ Symptoms) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐9.14 [‐12.91, ‐5.37] |
| 1.13.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐11.31 [‐16.58, ‐6.03] |
| 1.13.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐6.84 [‐15.77, 2.10] |
| 1.13.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐12.00 [‐22.41, ‐1.59] |
| 1.13.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐3.20 [‐12.08, 5.68] |
| 1.14 Change in quality of life (SGRQ Activity) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐1.41 [‐2.51, ‐0.30] |
| 1.14.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐1.54 [‐3.11, 0.02] |
| 1.14.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐1.07 [‐2.70, 0.56] |
| 1.14.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐1.80 [‐9.93, 6.33] |
| 1.14.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | ‐5.20 [‐12.82, 2.42] |
| 1.15 Change in quality of life (SGRQ Impact) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐3.57 [‐5.79, ‐1.35] |
| 1.15.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐4.73 [‐7.76, ‐1.69] |
| 1.15.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐4.59 [‐8.60, ‐0.57] |
| 1.15.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | 1.40 [‐7.05, 9.85] |
| 1.15.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | 2.90 [‐4.45, 10.25] |
| 1.16 Change in quality of life (SGRQ Total) at long‐term follow‐up Show forest plot | 4 | 463 | Mean Difference (IV, Fixed, 95% CI) | ‐3.60 [‐5.66, ‐1.55] |
| 1.16.1 All participants | 4 | 240 | Mean Difference (IV, Fixed, 95% CI) | ‐4.93 [‐7.81, ‐2.06] |
| 1.16.2 Idiopathic pulmonary fibrosis only | 2 | 89 | Mean Difference (IV, Fixed, 95% CI) | ‐3.45 [‐7.43, 0.52] |
| 1.16.3 Severe lung disease | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐1.90 [‐8.57, 4.77] |
| 1.16.4 Desaturators | 1 | 73 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐5.62, 5.82] |
| 1.17 Change in quality of life (Chronic Respiratory Disease Questionnaire (CRQ) Dyspnoea) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.72 [0.55, 0.88] |
| 1.17.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.68 [0.42, 0.93] |
| 1.17.2 Idiopathic pulmona ry fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.81 [0.49, 1.14] |
| 1.17.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.68 [0.21, 1.15] |
| 1.17.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.69 [0.30, 1.08] |
| 1.18 Change in quality of life (CRQ Fatigue) immediately following pulmonary rehabilitation. Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.66 [0.49, 0.82] |
| 1.18.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.66 [0.43, 0.90] |
| 1.18.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.67 [0.36, 0.98] |
| 1.18.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.65 [0.17, 1.13] |
| 1.18.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.60 [0.15, 1.06] |
| 1.19 Change in quality of life (CRQ Emotion) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.55 [0.40, 0.70] |
| 1.19.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.63 [0.42, 0.84] |
| 1.19.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.64 [0.33, 0.95] |
| 1.19.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.30 [‐0.15, 0.75] |
| 1.19.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.30 [‐0.09, 0.70] |
| 1.20 Change in quality of life (CRQ Mastery) immediately following pulmonary rehabilitation Show forest plot | 5 | 677 | Mean Difference (IV, Fixed, 95% CI) | 0.62 [0.46, 0.79] |
| 1.20.1 All participants | 5 | 321 | Mean Difference (IV, Fixed, 95% CI) | 0.67 [0.44, 0.90] |
| 1.20.2 Idiopathic pulmonary fibrosis only | 3 | 169 | Mean Difference (IV, Fixed, 95% CI) | 0.63 [0.33, 0.94] |
| 1.20.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.52 [‐0.04, 1.07] |
| 1.20.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | 0.49 [0.02, 0.96] |
| 1.21 Change in quality of life (CRQ Dyspnoea) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.25 [0.07, 0.44] |
| 1.21.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.42 [0.17, 0.68] |
| 1.21.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.26, 0.72] |
| 1.21.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.08 [‐0.42, 0.58] |
| 1.21.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.10 [‐0.54, 0.34] |
| 1.22 Change in quality of life (CRQ Fatigue) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.26 [0.05, 0.48] |
| 1.22.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.40 [0.09, 0.70] |
| 1.22.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.31 [‐0.20, 0.83] |
| 1.22.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.37, 0.69] |
| 1.22.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.04 [‐0.54, 0.46] |
| 1.23 Change in quality of life (CRQ Emotion) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.32 [0.13, 0.50] |
| 1.23.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.51 [0.26, 0.77] |
| 1.23.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.23, 0.70] |
| 1.23.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.29, 0.61] |
| 1.23.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.00 [‐0.42, 0.42] |
| 1.24 Change in quality of life (CRQ Mastery) at long‐term follow‐up Show forest plot | 4 | 551 | Mean Difference (IV, Fixed, 95% CI) | 0.27 [0.05, 0.50] |
| 1.24.1 All participants | 4 | 269 | Mean Difference (IV, Fixed, 95% CI) | 0.47 [0.17, 0.78] |
| 1.24.2 Idiopathic pulmonary fibrosis only | 2 | 95 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.47, 0.67] |
| 1.24.3 Severe lung disease | 2 | 84 | Mean Difference (IV, Fixed, 95% CI) | 0.23 [‐0.37, 0.83] |
| 1.24.4 Desaturators | 2 | 103 | Mean Difference (IV, Fixed, 95% CI) | ‐0.15 [‐0.68, 0.38] |
| 1.25 Long‐term survival Show forest plot | 4 | Odds Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.25.1 All participants | 4 | 291 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.40 [0.14, 1.12] |
| 1.25.2 Idiopathic pulmonary fibrosis only | 3 | 127 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.08, 1.19] |
| 1.25.3 Severe lung disease | 2 | 84 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.14, 2.05] |
| 1.25.4 Desaturators | 2 | 103 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.15, 2.35] |
