Effect of Pulmonary Rehabilitation Approaches on Dyspnea, Exercise Capacity, Fatigue, Lung Functions, and Quality of Life in Patients With COVID-19: A Systematic Review and Meta-analysis

Overview

Journal Arch Phys Med Rehabil

Specialty Rehabilitation Medicine

Date 2022 Jul 31

PMID 35908659

Authors

Ishtiaq Ahmed

Rustem Mustafaoglu

Ipek Yeldan

Zeynal Yasaci

Belgin Erhan

Affiliations

Soon will be listed here.

Abstract

Objective: To qualitatively synthesize and quantitatively evaluate the effect of pulmonary rehabilitation (PR) on dyspnea, lung functions, fatigue, exercise capacity, and quality of life (QoL) in patients with COVID-19.

Data Sources: PubMed, Web of Science, and Cochrane databases were searched from January 2020 to April 2022.

Data Selection: Randomized controlled trials (RCTs) assessing the effect of PR on dyspnea, lung functions, fatigue, exercise capacity, and QoL in patients with COVID-19.

Data Extraction: The mean difference (MD) and a 95% CI were estimated for all the outcome measures using random effect models. The following data were extracted by 2 independent reviewers: (1) first author; (2) publication year; (3) nationality; (4) number of patients included (5) comorbidities; (6) ventilatory support; (7) length of inpatient stay; (8) type of PR; (9) outcome measures; and (10) main findings. The risk of bias was evaluated using the cochrane risk of bias tool.

Data Synthesis: A total of 8 RCTs involving 449 participants were included in the review. PR was found to be significantly effective in improving dyspnea (5 studies, SMD -2.11 [95% CI, -2.96 to -1.27; P<.001]) and exercise capacity (MD 65.85 m [95% CI, 42.86 to 88.83; P<.001]) in patients with both acute and chronic COVID-19 with mild to severe symptoms, whereas fatigue (MD -2.42 [95% CI, -2.72 to -2.11, P<.05]) and lung functions (MD 0.26 L [95% CI, 0.04 to 0.48, P<.05]) were significantly improved in acute COVID-19 patients with mild symptoms. The effect of PR on QoL was inconsistent across studies. PR was found to be safe and feasible for patients with COVID-19.

Conclusion: Evidence from studies indicates that PR program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19. PR appears to be safe and beneficial for both acute and chronic COVID-19 patients.

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References

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Curci C, Negrini F, Ferrillo M, Bergonzi R, Bonacci E, Camozzi D . Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021; 57(3):443-450. DOI: 10.23736/S1973-9087.20.06660-5. View

Wan X, Wang W, Liu J, Tong T . Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14:135. PMC: 4383202. DOI: 10.1186/1471-2288-14-135. View

Sanchez-Ramirez D, Normand K, Zhaoyun Y, Torres-Castro R . Long-Term Impact of COVID-19: A Systematic Review of the Literature and Meta-Analysis. Biomedicines. 2021; 9(8). PMC: 8389585. DOI: 10.3390/biomedicines9080900. View

Gloeckl R, Leitl D, Jarosch I, Schneeberger T, Nell C, Stenzel N . Benefits of pulmonary rehabilitation in COVID-19: a prospective observational cohort study. ERJ Open Res. 2021; 7(2). PMC: 7957293. DOI: 10.1183/23120541.00108-2021. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62(10):e1-34. DOI: 10.1016/j.jclinepi.2009.06.006. View

Rodriguez-Blanco C, Bernal-Utrera C, Anarte-Lazo E, Saavedra-Hernandez M, De-La-Barrera-Aranda E, Serrera-Figallo M . Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial. Clin Rehabil. 2021; 36(4):486-497. DOI: 10.1177/02692155211061221. View

Pehlivan E, Palali I, Atan S, Turan D, Cinarka H, Cetinkaya E . The effectiveness of POST-DISCHARGE telerehabilitation practices in COVID-19 patients: Tele-COVID study-randomized controlled trial. Ann Thorac Med. 2022; 17(2):110-117. PMC: 9150661. DOI: 10.4103/atm.atm_543_21. View

Mahase E . Covid-19: What do we know about "long covid"?. BMJ. 2020; 370:m2815. DOI: 10.1136/bmj.m2815. View

10.

Halpin S, McIvor C, Whyatt G, Adams A, Harvey O, McLean L . Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2020; 93(2):1013-1022. DOI: 10.1002/jmv.26368. View

11.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

12.

Gonzalez-Gerez J, Saavedra-Hernandez M, Anarte-Lazo E, Bernal-Utrera C, Perez-Ale M, Rodriguez-Blanco C . Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study. Int J Environ Res Public Health. 2021; 18(14). PMC: 8306449. DOI: 10.3390/ijerph18147511. View

13.

Lau H, Ng G, Jones A, Lee E, Siu E, Hui D . A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother. 2005; 51(4):213-9. PMC: 7130114. DOI: 10.1016/s0004-9514(05)70002-7. View

14.

. [Recommendations for respiratory rehabilitation of coronavirus disease 2019 in adult]. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43(4):308-314. DOI: 10.3760/cma.j.cn112147-20200228-00206. View

15.

Rodriguez-Blanco C, Gonzalez-Gerez J, Bernal-Utrera C, Anarte-Lazo E, Perez-Ale M, Saavedra-Hernandez M . Short-Term Effects of a Conditioning Telerehabilitation Program in Confined Patients Affected by COVID-19 in the Acute Phase. A Pilot Randomized Controlled Trial. Medicina (Kaunas). 2021; 57(7). PMC: 8305888. DOI: 10.3390/medicina57070684. View

16.

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

17.

Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y . Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020; 39:101166. PMC: 7118596. DOI: 10.1016/j.ctcp.2020.101166. View

18.

Spruit M, Holland A, Singh S, Tonia T, Wilson K, Troosters T . COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force. Eur Respir J. 2020; 56(6. PMC: 7427118. DOI: 10.1183/13993003.02197-2020. View

19.

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y . Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015; (2):CD003793. PMC: 10008021. DOI: 10.1002/14651858.CD003793.pub3. View

20.

Ahmed I, Yeldan I, Mustafaoglu R . The Adjunct of Electric Neurostimulation to Rehabilitation Approaches in Upper Limb Stroke Rehabilitation: A Systematic Review With Network Meta-Analysis of Randomized Controlled Trials. Neuromodulation. 2022; 25(8):1197-1214. DOI: 10.1016/j.neurom.2022.01.005. View