Telerrehabilitación para la enfermedad respiratoria crónica
Información
- DOI:
- https://doi.org/10.1002/14651858.CD013040.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 29 enero 2021see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Vías respiratorias
- Copyright:
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- Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
NSC and AEH conceived the idea for this Cochrane Review. All protocol authors contributed to the development of the protocol. NSC will be guarantor of the review.
Contributions of editorial team
Chris Cates (Coordinating Editor) checked the data entry prior to the full write up of the review, edited the protocol; advised on methodology; approved the protocol prior to publication.
Emma Dennett (Managing Editor): coordinated the editorial process; advised on interpretation and content; edited the review.
Emma Jackson (Assistant Managing Editor): conducted peer review; obtained translations; edited the plain language summary and reference sections of the protocol and the review.
Elizabeth Stovold (Information Specialist): designed the search strategy; ran the searches; edited the search methods section.
Sources of support
Internal sources
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No sources of support supplied
External sources
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National Health and Medical Research Council (NHMRC), Australia
NSC is the holder of an NHMRC Early Career Fellowship (GNT1119970)
Declarations of interest
NSC: Dr Cox holds a National Health and Medical Research Council (NHMRC) Australia Early Career Fellowship (GNT1119970). She presented workshops relating to pulmonary rehabilitation (including alternative models of delivery) at the 2018 National General Practitioners Meeting sponsored by Boeringher Ingelheim and monies were paid to her host institution. Dr Cox is an author on trials included in this review.
SDC: Professor Dal Corso was supported by funding from Sao Paulo Research Foundation (FAPESP SPRINT grant 17/50273‐4), Brazil.
HH: Dr Hansen has received a personal post doctoral grants from the Capital Region of Copenhagen (governmental funding), teaching fee from GSK (private company), The association of Danish Physiotherapist (NGO) and royalties from educational books chapters written for Munksgaard Denmark (publisher). He is an author on trials included in this review.
CFM: Professor McDonald has developed educational presentations sponsored by Menarini and Astra Zeneca with monies to her institution. She has also received in kind support from Air Liquide for a clinical trial of oxygen therapy. She has received competitive research funding from the National Health and Medical Research Council (Australia) (GNT1101616) for a trial of telerehabilitation in COPD, and is an author on one of the trials included in this review. Professor McDonald is an author on trials included in this review.
CJH: none known
PZ: Dr Zanaboni holds a Research Council of Norway Project Grant (228919/H10) titled 'Long‐term integrated telerehabilitation of COPD patients: a multi centre randomised controlled trial'.
JAA: Professor Alison has received competitive research funding from the National Health and Medical Research Council (Australia) (GNT1101616) for a trial of telerehabilitation in COPD, and is an author on one of the trials included in this review.
POH: Dr O'Halloran is an author on one of the trials included in this review.
HM: none known
AEH: Professor Holland has received competitive research funding from the National Health and Medical Research Council (Australia) (GNT1101616) for a trial of telerehabilitation in COPD, and is an author on trials included in this review. The NHMRC supports the independent conduct and publication of this Cochrane Review.
Seven review authors (NSC, CFM, CJH, JAA, POH, HH, AEH) were co‐authors on at least one study included in this review. As such, at least one independent co‐author undertook data extraction and the assessment of risks of bias.
Acknowledgements
We thank Elizabeth Stovold from Cochrane Airways for her help with developing and conducting the search strategy; Dr Angela Burge for her practical assistance, and the pulmonary rehabilitation participants who provided consumer feedback. The authors and Airways Editorial Team are grateful to the following peer and consumer reviewers for their valuable time and comments: Elizabeth Berger, Ling Ling Tsai and Tania Janaudis‐Ferreira.
The Background and Methods sections of this review are based on a standard template used by Cochrane Airways.
This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Airways. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Jan 29 | Telerehabilitation for chronic respiratory disease | Review | Narelle S Cox, Simone Dal Corso, Henrik Hansen, Christine F McDonald, Catherine J Hill, Paolo Zanaboni, Jennifer A Alison, Paul O'Halloran, Heather Macdonald, Anne E Holland | |
| 2018 Jun 05 | Telerehabilitation for chronic respiratory disease | Protocol | Narelle S Cox, Christine F McDonald, Catherine J Hill, Paul O'Halloran, Jennifer A Alison, Paolo Zanaboni, Heather Macdonald, Anne E Holland | |
Differences between protocol and review
At the direction of the Cochrane editorial office, data from non‐randomised studies (NRS) were synthesized narratively, and were not combined with the results of randomised controlled trials.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Bias;
- Chronic Disease;
- Controlled Clinical Trials as Topic [statistics & numerical data];
- Dyspnea [rehabilitation];
- Exercise Tolerance [physiology];
- Internet [statistics & numerical data];
- Non-Randomized Controlled Trials as Topic [statistics & numerical data];
- Patient Compliance [statistics & numerical data];
- Pulmonary Disease, Chronic Obstructive [*rehabilitation];
- Quality of Life;
- Randomized Controlled Trials as Topic [statistics & numerical data];
- Respiration Disorders [*rehabilitation];
- Telephone [statistics & numerical data];
- Telerehabilitation [*methods, statistics & numerical data];
- Videoconferencing [statistics & numerical data];
- Walk Test [statistics & numerical data];
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Forest plot of comparison: 1 Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, outcome: 1.1 Outcome 1 Exercise capacity ‐ 6minute walk test distance at end intervention.
Forest plot of comparison: 1 Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, outcome: 1.8 Outcome 3 Dyspnoea ‐ Change in CRQ Dyspnoea domain at end intervention.
In the control group 70 people out of 100 completed treatment over 6 to 12 weeks, compared to 93 (95% CI 80 to 96) out of 100 for the active treatment group.
Forest plot of comparison: 3 Telerehabilitation vs no rehabilitation control, outcome: 3.1 Outcome 1 Exercise capacity ‐ 6minute walk distance at end intervention.
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 1: Outcome 1 Exercise capacity ‐ 6minute walk test distance at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 2: Outcome 1 Exercise capacity ‐ Change in endurance shuttle walk test time (seconds) at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 3: Outcome 1 Exercise capacity ‐ change in endurance cycle time at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 4: Outcome 1 Exercise capacity ‐ Peak watts on CPET at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 5: Outcome 1 Exercise capacity ‐ Change in 30 sec STS repetitions at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 6: Outcome 1 Exercise Capacity ‐ Long term (>6months) change in 6MWD from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 7: Outcome 3 Dyspnoea ‐ MMRC at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 8: Outcome 3 Dyspnoea ‐ Change in CRQ Dyspnoea domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 9: Outcome 3 Dyspnoea ‐ Long term (>6 months) change in CRQ Dyspnoea score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 10: Outcome 4 Quality of life ‐ SGRQ total score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 11: Outcome 4 Quality of life ‐ Change in SGRQ symptom score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 12: Outcome 4 Quality of life ‐ Change in SGRQ activity score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 13: Outcome 4 Quality of life ‐ Change in SGRQ impact score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 14: Outcome 4 Quality of life ‐ CAT score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 15: Outcome 4 Quality of life ‐ Change in CRQ Dyspnoea domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 16: Outcome 4 Quality of life ‐ Change in CRQ Fatigue domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 17: Outcome 4 Quality of life ‐ Change in CRQ Emotion domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 18: Outcome 4 Quality of life ‐ Change in CRQ Mastery domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 19: Outcome 4 Quality of life ‐ Change in CCQ Function domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 20: Outcome 4 Quality of life ‐ Change in CCQ Mental domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 21: Outcome 4 Quality of life ‐ Change in CCQ Symptom domain at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 22: Outcome 4 Quality of life ‐ Change in CCQ total score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 23: Outcome 4 Quality of life ‐ Change in EQ‐5D‐VAS score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 24: Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Dyspnoea score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 25: Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Fatigue score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 26: Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Emotion score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 27: Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Mastery score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 28: Outcome 5 Completion of the intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 29: Outcome 6 Anxiety/Depression ‐ Change in HADS Anxiety score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 30: Outcome 6 Anxiety/Depression ‐ Change in HADS Depression score at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 31: Outcome 6 Anxiety/Depression ‐ Long term (>6 months) change in HADS Anxiety score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 32: Outcome 6 Anxiety/Depression ‐ Long term (>6 months) change in HADS Depression score from baseline to end followup
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 33: Outcome 7 Physical activity ‐ Change in MVPA time (minutes/day) at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 34: Outcome 7 Physical activity ‐ Sedentary time (minutes/day) at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 35: Outcome 7 Physical activity ‐ Change in steps/day at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 36: Outcome 7 Physical Activity ‐ Change in total daily Energy Expenditure (k/cal) at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 37: Outcome 7 Physical activity ‐ Light physical activity time (minutes)/day at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 38: Outcome 7 Physical Activity ‐ Lifestyle physical activity time (minutes)/day at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 39: Outcome 7 Physical Activity ‐ Moderate physical activity time (minutes)/day at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 40: Outcome 7 Physical activity ‐ Change in time active (minutes) at end intervention
Comparison 1: Telerehabilitation vs Centre‐based (outpatient) pulmonary rehabilitation, Outcome 41: Outcome 8 Health care utilisation ‐ Respiratory related hospitalisation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 1: Outcome 1 Exercise capacity ‐ 6minute walk distance at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 2: Outcome 1 Exercise capacity ‐ Peak watts on CPET at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 3: Outcome 1 Exercise capacity ‐ Change in ISWT distance at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 4: Outcome 1 Exercise capacity ‐ Change in ESWT time at end of intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 5: Outcome 3 Dyspnoea ‐ Change in CRQ Dyspnoea domain at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 6: Outcome 3 Dyspnoea ‐ Change in exercise isotime breathlessness score at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 7: Outcome 3 Dyspnoea ‐ MMRC at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 8: Outcome 4 Quality of life ‐ SGRQ total score at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 9: Outcome 4 Quality of life ‐ CAT score at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 10: Outcome 4 Quality of life ‐ Change in CRQ total score at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 11: Outcome 4 Quality of life ‐ Change in CRQ Dyspnoea domain at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 12: Outcome 4 Quality of life ‐ Change in CRQ Fatigue domain at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 13: Outcome 4 Quality of life ‐ Change in CRQ Emotion domain at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 14: Outcome 4 Quality of life ‐ Change in CRQ Mastery domain at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 15: Outcome 4 Quality of life ‐ Change in MLHFQ at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 16: Outcome 5 Anxiety/Depression ‐ Change in HADS Anxiety score at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 17: Outcome 5 Anxiety/Depression ‐ Change in HADS Depression score at end interveniton
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 18: Outcome 6 Physical activity ‐ Change in total Energy Expenditure (kcal)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 19: Outcome 6 Physical activity ‐ Change in steps/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 20: Outcome 6 Physical activity ‐ Sedentary time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 21: Outcome 6 Physical activity ‐ Light physical activity time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 22: Outcome 6 Physical activity ‐ Lifestyle physical activity time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 23: Outcome 6 Physical activity ‐ Moderate intensity physical activity time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 24: Outcome 6 Physical activity ‐ Change in Vigorous physical activity time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 25: Outcome 6 Physical activity ‐ Change in Very Vigorous physical activity time (minutes)/day at end intervention
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 26: Outcome 6 Physical activity ‐ Change in number sedentary bouts/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 27: Outcome 6 Physical activity ‐ Change in time spent in sedentary bouts minutes/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 28: Outcome 6 Physical activity ‐ Change in moderate‐vigorous physical activity time minutes/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 29: Outcome 6 Physical activity ‐ Change in number of bouts moderate‐vigorous physical activity/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 30: Outcome 6 Physical activity ‐ Change in time spent in moderate‐vigorous bouts, minutes/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 31: Outcome 6 Physical activity ‐ Change in metabolic equivalents (METs)/day at end rehabilitation
Comparison 3: Telerehabilitation vs no rehabilitation control, Outcome 32: Outcome 7 ‐ Health care utilisation
| Telerehabilitation compared to centre‐based (outpatient) pulmonary rehabilitation for chronic respiratory disease | ||||||
| Patient or population: Chronic respiratory disease | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with centre‐based (outpatient) pulmonary rehabilitation | Risk with telerehabilitation | |||||
| Primary rehabilitation | ||||||
| Exercise capacity ‐ | The change in 6MWD in the control groups ranged from 11 m to 29 m | Mean change in 6MWD was 0.06 mhigher in the telerehabilitation groups | MD 0.06 (‐10.82 to 10.94 | 556 | ⊕⊕⊕⊝ | |
| Breathlessness ‐ CRQ dyspnoea domain | The mean change in CRQ dyspnoea in the control groups was 0.7 points | The mean change in CRQ dyspnoea was 0.13 points higher in the telerehabilitation groups | MD 0.13 | 394 | ⊕⊕⊝⊝ | |
| Quality of life ‐ SGRQ Lower scores indicating better quality of life | The change in SGRQ in the control groups ranged from ‐6.3 to 1.6 points | The mean change in SGRQ score was 1.3 points lower in the telerehabilitation groups | MD ‐1.26 | 274 | ⊕⊕⊝⊝ | The MCID for the SGRQ is 4 points |
| Quality of life ‐ CAT | The change in CAT in the control groups ranged from ‐1.1 to ‐0.3 points | The mean change in CAT score was 1.4 points lower in the telerehabilitation groups | MD 1.37 | 224 | ⊕⊕⊕⊝ | |
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1High risk of bias for performance bias 2High risk of bias for performance bias and possibly reporting bias 3Risk of imprecision due to width of confidence intervals 4Risk of inconsistency due to limited overlap of confidence intervals | ||||||
| Telerehabilitation compared to no rehabilitation control for chronic respiratory disease | ||||||
| Patient or population: Chronic respiratory disease | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with no rehabilitation control | Risk with telerehabilitation | |||||
| Primary rehabilitation | ||||||
| Exercise capacity ‐ 6MWD (m) | The mean change in 6MWD in the control groups was 10 m | The mean change in the telerehabilitation groups was 22 m higher | MD 22.17 | 94 | ⊕⊕⊝⊝ | |
| Breathlessness ‐ CRQ dyspnoea domain | The mean change in CRQ dyspnoea in the control groups was 0.6 points | The mean change in the telerehabilitation groups was 2 points higher | MD 1.97 | 94 | ⊕⊕⊝⊝ | This difference was measured using a maximum score of 35 on the CRQ scale, so would be equivalent to a mean difference of 0.06 units on a 7‐point scale. |
| Quality of life ‐ CRQ total score | The mean change in CRQ total score in the control groups was 3.3 points | The mean change in the telerehabilitation groups was 7 points higher | MD 6.90 | 94 | ⊕⊕⊝⊝ | This difference was measured using a maximum score of 140 on the CRQ scale, so would be equivalent to a mean difference of 0.345 units on a 7‐point scale. |
| Quality of life ‐ CRQ dyspnoea domain | The mean change in CRQ dyspnoea domain in the control groups was 0.6 points | The mean change in the telerehabilitation groups was 2 points higher | MD 1.97 | 94 | ⊕⊕⊝⊝ | |
| Maintenance rehabilitation | ||||||
| Exercise capacity ‐ 6MWD (m) | The change in 6MWD in the control groups ranged from ‐45 to ‐15 m | The mean change in the maintenance telerehabilitation groups was 78 m higher | MD 78.10 | 209 | ⊕⊕⊝⊝ | |
| Dyspnoea ‐ mMRC | The change in mMRC in the control groups ranged from 0.07 to 0.9 points | The mean change in the maintenance telerehabilitation groups was 0.86points lower | MD ‐0.86, 95% CI ‐2.10 to 0.37; participants ) | 189 | ⊕⊝⊝⊝ | I2 = 97% |
| Quality of life ‐ CAT | The change in CAT in the control groups ranged from 1.6 to 5.1 points | The mean change in the maintenance telerehabilitation groups was 7 points lower | MD ‐7.34 | 189 | ⊕⊝⊝⊝ | |
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1High risk of bias for performance bias 2Risk of imprecision due to width of confidence intervals 3High risk of bias for performance bias and detection bias 4Risk of inconsistency due to high degree of heterogeneity | ||||||
| Study | Intervention technology | Reported issues |
|---|---|---|
| Hub and spoke telerehabilitation using videoconferencing (Polycom Real Presence Group 500 Video Conferencing System and Samsung DM65E‐BR interactive screens, installed by Comcen). | The videoconferencing connection was lost in two out of 452 sessions, and sites were reconnected by redialing. Some participants had difficulty hearing a presentation in an early session which was resolved by microphone replacement and the closing of curtains to reduce echo. | |
| In home telerehabilitation using video conferencing software installed on a single touch screen. | Major technical issues leading to cancellation and rescheduling of group sessions 2 of 360 group sessions. Minor technical issues (i.e., sound artefacts, screen freezes) not Individual patient cancellation caused | |
| In home telerehabilitation using video conferencing and a tablet computer | Out of a total of 197 exercise training sessions there were 24 technical issues (12%) related to the use of technology (e.g. poor internet connection). |
| Study: Barbaren‐Garcia 2014 (Barcelona and Athens) | ||
|---|---|---|
| ROBINS‐I domain | Risk of Bias | Description |
| Bias due to confounding | Serious | Confounding associated with country, socioeconomic status and health system inherently unable to be controlled for. Different components to information communication technology (ICT) support in both sub‐studies. |
| Bias in selection of participants | Critical | Patients were allocated to the intervention or control group depending on availability of mobile phones with wireless sensors (Barcelona). Control group assessed first and afterward the intervention group due to delays in deployment of technological platform (Athens) |
| Bias in classification of interventions | Serious | Baseline cardiopulmonary rehabilitation and intervention differed between countries, however comparisons were not made between countries. |
| Bias due to deviations from intended interventions | Serious | Unable to determine if study participants adhered to the intervention; much larger drop out in the control group than intervention group ‐ authors proposed this is due to issues with ICT in 54% of cases and access (travel) in another 25% (with proposed reason for dropout only noted for Barcelona study group) |
| Bias due to missing data | Serious | Large losses to follow up (47% Barcelona, 56% Athens) from the control groups. Reasons for loss to follow up from intervention groups not stated. |
| Bias in measurement of outcomes | Moderate | Standard tests common across groups and study sites, but unclear if outcome assessors blind. Much longer follow up for Barcelona study (mean (SD) 22 (12) months vs 12 months) |
| Bias in selection of the reported result | Moderate | Pre and post data presented for Barcelona group, change data presented for Athens group. SGRQ total and activity domain only presented for Barcelona group, component of SGRQ reported for Athens unclear (change data only). |
| Overall bias | Critical | |
| Study: Knox 2019 | ||
| ROBINS‐I domain | Risk of Bias | Description |
| Bias due to confounding | Serious | Socio‐economic status (regional vs metropolitan) unable to be accounted for. May favour control group. |
| Bias in selection of participants | Serious | Selection into the study was on the basis of the intervention and this was unable to be controlled for in the analysis. |
| Bias in classification of interventions | Low | Intervention groups were clearly defined. |
| Bias due to deviations from intended interventions | Moderate | Co‐interventions balanced across groups (education delivered via videoconference from Hub site in real time). Hub staff were able to travel to Spoke site at their discretion if deemed more support was needed. This protocol deviation only impacted Spoke intervention sites and impact on outcomes is not able to be accounted for. |
| Bias due to missing data | No information | No information or insufficient information is reported about missing data. Reasons for missing data are not described. Numbers of individuals who completed the end intervention assessment are not reported in the paper. Only complete data set outcomes are reported for ISWT ‐ other outcomes unclear (author communication) |
| Bias in measurement of outcomes | Moderate | Standardised assessments used (ISWT, CAT, HADS, MRC), but unclear if assessors were aware of intervention |
| Bias in selection of the reported result | No information | There is too little information to make a judgement |
| Overall bias | Serious | |
| Study: Stickland 2011 | ||
| ROBINS‐I domain | Risk of Bias | Description |
| Bias due to confounding | Serious | Socio‐economic status (regional vs metropolitan) unable to be accounted for. May favour control group. |
| Bias in selection of participants | Low | All enrolled participants had confirmed diagnosis of COPD. Inclusion and exclusion criteria applied equally across both groups. |
| Bias in classification of interventions | Low | Intervention groups were clearly defined and information to define characteristics of groups presented at the start of the intervention (baseline characteristics). Classification of intervention based on geography |
| Bias due to deviations from intended interventions | Low | Co‐interventions balanced across group. Average number of sessions attended similar in both intervention (telehealth average 12.6 sessions) and control (standard pulmonary rehabilitation average 13.2 sessions) |
| Bias due to missing data | Moderate | High follow up and imputation analysis at end intervention; but significant loss to follow up data at 6‐months and unable to perform imputation analysis |
| Bias in measurement of outcomes | Moderate | Standardised assessments used (12min walk test and SGRQ), but unclear if assessors were aware of intervention |
| Bias in selection of the reported result | Low | All outcome measures reported appropriately including total score and all domain scores of the SGRQ |
| Overall bias | Moderate | |
| CAT: COPD assessment test; COPD: chronic obstructive pulmonary disease; HADS: Hospital Anxiety and Depression Scale;ISWT: incremental shuttle walk test; MRC: medical research council dyspnoea scale; SD: standard deviation; SGRQ: St George's Respiratory Questionnaire. | ||
| Study | Adverse events details |
|---|---|
| Not recorded as an outcome or reported. | |
| Not recorded as an outcome or reported. | |
| PROTOCOL:
PAPER:
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| PROTOCOL:
PAPER:
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| Not recorded as an outcome or reported. | |
| Not recorded as an outcome or reported. | |
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| Definition of adverse event not specified. Reasons for patient dropout that could be considered adverse event detailed in Table 4 (PAPER).
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| Not recorded as an outcome or reported. | |
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| Abbreviations: AE, adverse event; COPD, chronic obstructive pulmonary disease; HBP, home‐based program; PR, pulmonary rehabilitation; PTR, pulmonary tele‐rehabilitation. | |
| Study | Comparison | Definition for Adherence/Completion | Result |
|---|---|---|---|
| 3 (maintenance) | Not defined | Not reported | |
| 3 (maintenance) | Not defined |
| |
| 3 (maintenance) | Not defined |
| |
| 1 | Not defined |
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| 1 | Reached stage 3 or above of the web program, achieving 75% of the program |
| |
| 1 | Undertaking a minimum of 70% of the planned pulmonary rehabilitation sessions |
| |
| 1 | Undertaking a minimum of 70% of the planned pulmonary rehabilitation sessions |
| |
| 1 | Not defined |
| |
| 3 | Not defined | Not reported | |
| 3 | Not defined |
| |
| 1 | Completion of at least 60% (n = 15) of the exercise training sessions |
| |
| 1 | To attend a minimum of nine of the 16 sessions |
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| 3 | Not defined |
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| 3 | Compliance with telerehabilitation sessions was recorded by the number of completed exercise training sessions as prescribed out of a possible 24 sessions. |
| |
| 1, 3 (maintenance) | Adherence to home‐based maintenance tele‐rehabilitation and hospital‐based maintenance programs was assessed by the adherence rate (actual number of sessions/total expected number of sessions*100). |
| |
| Abbreviations: COPD, chronic obstructive pulmonary disease; n, number; SD, standard deviation. | |||
| Study | Comparison | Outcome | Timepoint | Telerehabilitation | Control |
|---|---|---|---|---|---|
| 3 | Use of healthcare resources. | During follow up intervention period | Barcelona (CCT): no difference between groups Athens (CCT): no data reported | ||
| 3 | No data reported | ||||
| 3 | Median time to event hospitalisation (any cause) or death | During the 4 month study period | 113.4 days | 104.7 days* | |
| Number of hospitalisations | During the 4 month study period | 21 (11 for cardiovascular diseases, 6 for respiratory diseases, 5 for other causes) | 37 (25 for cardiovascular diseases, 11 for respiratory diseases, 1 for other causes) | ||
| 1 | No data reported | ||||
| 1 | No data reported | ||||
| 1 | Number hospitalisations related to COPD | During intervention | 21 | 20 | |
| At 22 weeks follow‐up from baseline | 38 | 36 | |||
| Hospital days relating to all admissions, per admission/patient (median [IQR]) | At 22 weeks follow‐up from baseline | 2.3 [1.3 to 3.4] | 2.2 [1.1 to 4.7] | ||
| Hospital days relating to all admissions, total admissions/patient (median [IQR]) | At 22 weeks follow‐up from baseline | 11.8 [3.4 to 27.8] | 5.2 [3.2 to 13.8] | ||
| Hospital days for respiratory admissions, per admission/patient (median [IQR]) | At 22 weeks follow‐up from baseline | 2.4 [1.6 to 3.7] | 2.5 [1.2 to 5.2] | ||
| Hospital days for respiratory admissions, total admissions/patient (median [IQR]) | At 22 weeks follow‐up from baseline | 7.5 [3.1 to 14.4] | 5.2 [2.6 to 10.0] | ||
| Number of outpatient visits | At 10 weeks follow‐up from baseline | 113 | 744 | ||
| At 22 weeks follow‐up from baseline | 270 | 899 | |||
| 1 | Proportion with a hospital admission | During 12 months follow up after completion of intervention | n = 28 (35%) | n = 37 (43%) | |
| Proportion with a respiratory admission | During 12 months follow up after completion of intervention | n = 17 (21%) | n = 29 (34%)* | ||
| Number all cause hospital admissions per participant (median [IQR]) | During 12 months follow up after completion of intervention | 0 [0‐2] | 0 [0‐1.25] | ||
| Number all cause hospital days (median [IQR]) | During 12 months follow up after completion of intervention | 0 [0‐3.75] | 0 [0‐6.25] | ||
| Number of respiratory admissions (median [IQR]) | During 12 months follow up after completion of intervention | 0 [0‐0] | 0 [0‐1] | ||
| Number hospital days for respiratory cause (median [IQR]) | During 12 months follow up after completion of intervention | 0 [0‐0] | 0 [0‐5] | ||
| 3 | No data reported | ||||
| 3 | No data reported | ||||
| 3 | No data reported | ||||
| 1 | Number of COPD exacerbations | During intervention period | 9 | 14 | |
| During maintenance phase | 43 | 37 | |||
| Number of hospitalisations | During entire study period | 50 (not COPD related n = 31) | 51 (not COPD related n = 21) | ||
| 1 | Number of hospitalisations | During rehabilitation period | 3 | 3 | |
| Number of respiratory exacerbations | During rehabilitation period | 6 | 7 | ||
| 3 | Number of COPD exacerbations | During study intervention period | 33 | not applicable | |
| Number of hospitalisations, COPD | 4 | 5 | |||
| Number of hospitalisations, other | 4 | 2 | |||
| Emergency department visits for COPD | 5 | 5 | |||
| Length of stay, hospitalisation for COPD | 22 days | 36 days | |||
| Length of hospital stay for COPD, days (median [IQR]) | 5.5 [4.8‐6.3] | 7.0 [6.0‐7.0] | |||
| 3 | No data reported | ||||
| 1 (maintenance) | Acute exacerbation of COPD (mean±SD): | During 12 month maintenance intervention | 1.7±1.7 | 1.8 ± 1.4* | |
| 3 (maintenance) | 3.5 ± 1.8* | ||||
| 1 (maintenance) | Hospitalisation for acute exacerbation COPD (mean±SD): | 0.3±0.7 | 0.3 ± 0.6* | ||
| 3(maintenance) | 1.2 ± 1.7* | ||||
| 1 (maintenance) | Emergency department visits (mean±SD): | 0.5±0.9 | 1.8 ± 1.5* | ||
| 3 (maintenance) | 3.8 ± 1.5* | ||||
| Abbreviations: CCT, controlled clinical trial; COPD, chronic obstructive pulmonary disease; ED, emergency department; IQR, interquartile range; n, number; PR, pulmonary rehabilitation; SD, standard deviation. *between group difference P < 0.05 | |||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Outcome 1 Exercise capacity ‐ 6minute walk test distance at end intervention Show forest plot | 5 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.1.1 Randomised controlled trials ‐ Primary rehabilitation | 4 | 556 | Mean Difference (IV, Random, 95% CI) | 0.06 [‐10.82, 10.94] |
| 1.1.2 Randomised controlled trials ‐ Maintenance rehabilitation | 1 | 97 | Mean Difference (IV, Random, 95% CI) | ‐7.30 [‐34.93, 20.33] |
| 1.2 Outcome 1 Exercise capacity ‐ Change in endurance shuttle walk test time (seconds) at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.2.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.3 Outcome 1 Exercise capacity ‐ change in endurance cycle time at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.3.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.4 Outcome 1 Exercise capacity ‐ Peak watts on CPET at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.4.1 Maintenance rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.5 Outcome 1 Exercise capacity ‐ Change in 30 sec STS repetitions at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.5.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.6 Outcome 1 Exercise Capacity ‐ Long term (>6months) change in 6MWD from baseline to end followup Show forest plot | 2 | 308 | Mean Difference (IV, Random, 95% CI) | 1.40 [‐12.62, 15.43] |
| 1.7 Outcome 3 Dyspnoea ‐ MMRC at end intervention Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.7.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.7.2 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.8 Outcome 3 Dyspnoea ‐ Change in CRQ Dyspnoea domain at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.8.1 Randomised controlled trials ‐ Primary rehabilitation | 3 | 426 | Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.13, 0.40] |
| 1.9 Outcome 3 Dyspnoea ‐ Long term (>6 months) change in CRQ Dyspnoea score from baseline to end followup Show forest plot | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.14 [‐0.08, 0.36] |
| 1.10 Outcome 4 Quality of life ‐ SGRQ total score at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.10.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 274 | Mean Difference (IV, Random, 95% CI) | ‐1.26 [‐3.97, 1.45] |
| 1.10.2 Randomised controlled trials ‐ Maintenance rehabilitation | 1 | 97 | Mean Difference (IV, Random, 95% CI) | 4.80 [‐2.63, 12.23] |
| 1.11 Outcome 4 Quality of life ‐ Change in SGRQ symptom score at end intervention Show forest plot | 1 | Std. Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.11.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Std. Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.12 Outcome 4 Quality of life ‐ Change in SGRQ activity score at end intervention Show forest plot | 1 | Std. Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.12.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Std. Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.13 Outcome 4 Quality of life ‐ Change in SGRQ impact score at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.13.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.14 Outcome 4 Quality of life ‐ CAT score at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.14.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 224 | Mean Difference (IV, Random, 95% CI) | ‐1.37 [‐3.10, 0.36] |
| 1.14.2 Maintenance rehabilitation | 1 | 97 | Mean Difference (IV, Random, 95% CI) | 1.20 [‐1.40, 3.80] |
| 1.15 Outcome 4 Quality of life ‐ Change in CRQ Dyspnoea domain at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.15.1 Randomised controlled trials ‐ Primary rehabilitation | 3 | 426 | Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.13, 0.39] |
| 1.16 Outcome 4 Quality of life ‐ Change in CRQ Fatigue domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.16.1 Randomised controlled trials ‐ Primary rehabilitation | 2 | 364 | Mean Difference (IV, Random, 95% CI) | ‐0.03 [‐0.24, 0.18] |
| 1.17 Outcome 4 Quality of life ‐ Change in CRQ Emotion domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.17.1 Randomised controlled trials ‐ Primary rehabilitation | 2 | 364 | Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.20, 0.16] |
| 1.18 Outcome 4 Quality of life ‐ Change in CRQ Mastery domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.18.1 Randomised controlled trials ‐ Primary rehabilitation | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.03 [‐0.17, 0.23] |
| 1.19 Outcome 4 Quality of life ‐ Change in CCQ Function domain at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.19.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.20 Outcome 4 Quality of life ‐ Change in CCQ Mental domain at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.20.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.21 Outcome 4 Quality of life ‐ Change in CCQ Symptom domain at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.21.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.22 Outcome 4 Quality of life ‐ Change in CCQ total score at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.22.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.23 Outcome 4 Quality of life ‐ Change in EQ‐5D‐VAS score at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.23.1 Randomised controlled trials ‐ Primary rehabiliation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.24 Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Dyspnoea score from baseline to end followup Show forest plot | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.14 [‐0.08, 0.36] |
| 1.25 Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Fatigue score from baseline to end followup Show forest plot | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.31, 0.35] |
| 1.26 Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Emotion score from baseline to end followup Show forest plot | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.04 [‐0.13, 0.21] |
| 1.27 Outcome 4 Quality of Life ‐ Long term (>6 months) change in CRQ Mastery score from baseline to end followup Show forest plot | 2 | 364 | Mean Difference (IV, Random, 95% CI) | 0.09 [‐0.11, 0.30] |
| 1.28 Outcome 5 Completion of the intervention Show forest plot | 3 | Odds Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.28.1 Randomised controlled trials ‐ primary rehabilitation | 3 | 516 | Odds Ratio (M‐H, Fixed, 95% CI) | 5.36 [3.12, 9.21] |
| 1.29 Outcome 6 Anxiety/Depression ‐ Change in HADS Anxiety score at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.29.1 Randomised controlled trials ‐ Primary rehabilitation | 2 | 282 | Mean Difference (IV, Random, 95% CI) | ‐1.05 [‐1.76, ‐0.35] |
| 1.30 Outcome 6 Anxiety/Depression ‐ Change in HADS Depression score at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.30.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 282 | Mean Difference (IV, Random, 95% CI) | ‐0.36 [‐1.05, 0.34] |
| 1.31 Outcome 6 Anxiety/Depression ‐ Long term (>6 months) change in HADS Anxiety score from baseline to end followup Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.32 Outcome 6 Anxiety/Depression ‐ Long term (>6 months) change in HADS Depression score from baseline to end followup Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.33 Outcome 7 Physical activity ‐ Change in MVPA time (minutes/day) at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.33.1 Randomised controlled trial ‐ Primary rehabiliation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.34 Outcome 7 Physical activity ‐ Sedentary time (minutes/day) at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.34.1 Randomised controlled trial ‐ Primary rehabiliation | 2 | 192 | Mean Difference (IV, Random, 95% CI) | ‐8.57 [‐66.69, 49.54] |
| 1.34.2 Randomised controlled trials ‐ Maintenance rehabilitation | 1 | 97 | Mean Difference (IV, Random, 95% CI) | 34.00 [‐225.49, 293.49] |
| 1.35 Outcome 7 Physical activity ‐ Change in steps/day at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.35.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 192 | Mean Difference (IV, Random, 95% CI) | 387.09 [‐84.64, 858.81] |
| 1.36 Outcome 7 Physical Activity ‐ Change in total daily Energy Expenditure (k/cal) at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.36.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.37 Outcome 7 Physical activity ‐ Light physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.37.1 Randomised controlled trial ‐ Maintenance rehabiliation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.38 Outcome 7 Physical Activity ‐ Lifestyle physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.38.1 Randomised controlled trial ‐ Maintenance rehabiliation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.39 Outcome 7 Physical Activity ‐ Moderate physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.39.1 Randomised controlled trial ‐ Maintenance rehabiliation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.40 Outcome 7 Physical activity ‐ Change in time active (minutes) at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.40.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.41 Outcome 8 Health care utilisation ‐ Respiratory related hospitalisation Show forest plot | 3 | Odds Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.41.1 Randomised controlled trials ‐ Primary rehabilitation | 3 | 516 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.65 [0.43, 0.99] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Outcome 1 Exercise capacity ‐ 6minute walk distance at end intervention Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.1.1 Randomised controlled trials ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 22.17 [‐38.89, 83.23] |
| 3.1.2 Maintenance rehabilitation | 2 | 209 | Mean Difference (IV, Random, 95% CI) | 78.10 [49.60, 106.60] |
| 3.2 Outcome 1 Exercise capacity ‐ Peak watts on CPET at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.2.1 Randomise controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.3 Outcome 1 Exercise capacity ‐ Change in ISWT distance at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.3.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.4 Outcome 1 Exercise capacity ‐ Change in ESWT time at end of intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.4.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.5 Outcome 3 Dyspnoea ‐ Change in CRQ Dyspnoea domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.5.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 1.97 [‐1.07, 5.02] |
| 3.6 Outcome 3 Dyspnoea ‐ Change in exercise isotime breathlessness score at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.6.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.7 Outcome 3 Dyspnoea ‐ MMRC at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.7.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | 58 | Mean Difference (IV, Random, 95% CI) | 0.00 [‐0.61, 0.61] |
| 3.7.2 Randomised controlled trial ‐ Maintenance rehabilitation | 2 | 189 | Mean Difference (IV, Random, 95% CI) | ‐0.86 [‐2.10, 0.37] |
| 3.8 Outcome 4 Quality of life ‐ SGRQ total score at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.8.1 Randomised controlled trial ‐Maintenance rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.9 Outcome 4 Quality of life ‐ CAT score at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.9.1 Randomised controlled trial ‐ Primary rehabiliation | 1 | 36 | Mean Difference (IV, Random, 95% CI) | ‐4.00 [‐7.35, ‐0.65] |
| 3.9.2 Randomised controlled trial ‐ Maintenance rehabilitation | 2 | 189 | Mean Difference (IV, Random, 95% CI) | ‐7.34 [‐9.20, ‐5.48] |
| 3.10 Outcome 4 Quality of life ‐ Change in CRQ total score at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.10.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 6.90 [‐0.57, 14.36] |
| 3.11 Outcome 4 Quality of life ‐ Change in CRQ Dyspnoea domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.11.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 1.97 [‐1.07, 5.02] |
| 3.12 Outcome 4 Quality of life ‐ Change in CRQ Fatigue domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.12.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 2.30 [0.31, 4.30] |
| 3.13 Outcome 4 Quality of life ‐ Change in CRQ Emotion domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.13.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 2.43 [‐0.98, 5.85] |
| 3.14 Outcome 4 Quality of life ‐ Change in CRQ Mastery domain at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.14.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 0.30 [‐1.54, 2.14] |
| 3.15 Outcome 4 Quality of life ‐ Change in MLHFQ at end intervention Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.15.1 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.16 Outcome 5 Anxiety/Depression ‐ Change in HADS Anxiety score at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.16.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.17 Outcome 5 Anxiety/Depression ‐ Change in HADS Depression score at end interveniton Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.17.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.18 Outcome 6 Physical activity ‐ Change in total Energy Expenditure (kcal)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.18.1 Randomised controlled trials ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.19 Outcome 6 Physical activity ‐ Change in steps/day at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.19.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 488.78 [‐142.84, 1120.40] |
| 3.20 Outcome 6 Physical activity ‐ Sedentary time (minutes)/day at end intervention Show forest plot | 3 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.20.1 Randomised controlled trial ‐ Primary rehabilitation | 2 | 94 | Mean Difference (IV, Random, 95% CI) | 42.44 [‐25.77, 110.66] |
| 3.20.2 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | 97 | Mean Difference (IV, Random, 95% CI) | ‐29.00 [‐299.13, 241.13] |
| 3.21 Outcome 6 Physical activity ‐ Light physical activity time (minutes)/day at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.21.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.21.2 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.22 Outcome 6 Physical activity ‐ Lifestyle physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.22.1 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.23 Outcome 6 Physical activity ‐ Moderate intensity physical activity time (minutes)/day at end intervention Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.23.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.23.2 Randomised controlled trial ‐ Maintenance rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.24 Outcome 6 Physical activity ‐ Change in Vigorous physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.24.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.25 Outcome 6 Physical activity ‐ Change in Very Vigorous physical activity time (minutes)/day at end intervention Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.25.1 Randomised controlled trial ‐ Primary rehabilitation | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.26 Outcome 6 Physical activity ‐ Change in number sedentary bouts/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.27 Outcome 6 Physical activity ‐ Change in time spent in sedentary bouts minutes/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.28 Outcome 6 Physical activity ‐ Change in moderate‐vigorous physical activity time minutes/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.29 Outcome 6 Physical activity ‐ Change in number of bouts moderate‐vigorous physical activity/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.30 Outcome 6 Physical activity ‐ Change in time spent in moderate‐vigorous bouts, minutes/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.31 Outcome 6 Physical activity ‐ Change in metabolic equivalents (METs)/day at end rehabilitation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.32 Outcome 7 ‐ Health care utilisation Show forest plot | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 3.32.1 Randomised controlled trials ‐ maintenance rehabilitation | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
