Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review

doi:10.1016/j.apmr.2016.05.017

Archives of Physical Medicine and Rehabilitation

Volume 98, Issue 4, April 2017, Pages 774-782.e1

https://doi.org/10.1016/j.apmr.2016.05.017 Get rights and content

Abstract

Objective

To examine the effect of pulmonary rehabilitation (PR) (exercise and education) or exercise training (ET) on exercise capacity, health-related quality of life (HRQOL), symptoms, frequency of exacerbations, and mortality compared with no treatment in adults with bronchiectasis.

Data Sources

Computer-based databases were searched from their inception to February 2016.

Study Selection

Randomized controlled trials of PR or ET versus no treatment in adults with bronchiectasis were included.

Data Extraction

Two reviewers independently extracted data and assessed methodologic quality using the Cochrane risk-of-bias tool.

Data Synthesis

Four trials with 164 participants were included, with variable study quality. Supervised outpatient PR or ET of 8 weeks improved incremental shuttle walk distance (weighted mean difference [WMD]=67m; 95% confidence interval [CI], 52–82m) and disease-specific HRQOL (WMD=−4.65; 95% CI, −6.7 to −2.6 units) immediately after intervention, but these benefits were not sustained at 6 months. There was no effect on cough-related quality of life (WMD=1.3; 95% CI, −0.9 to 3.4 units) or psychological symptoms. PR commenced during an acute exacerbation and continued beyond discharge had no effect on exercise capacity or HRQOL. The frequency of exacerbations over 12 months was reduced with outpatient ET (median, 2 vs 1; P=.013), but PR initiated during an exacerbation had no impact on exacerbation frequency or mortality.

Conclusions

Short-term improvements in exercise capacity and HRQOL were achieved with supervised PR and ET programs, but sustaining these benefits is challenging in people with bronchiectasis. The frequency of exacerbations over 12 months was reduced with ET only.

Section snippets

Search strategy

The primary search strategy used electronic databases of MEDLINE, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and Physiotherapy Evidence Database from inception to May 2015. The search was updated in February 2016. The key terms were “bronchiectasis/non-cystic fibrosis bronchiectasis/non-CF bronchiectasis/ciliary motility disease/Kartagener's syndrome,” “rehabilitation/respiratory therapy/exercise/exercise movement techniques/exercise therapy/physical fitness,”

Results

A total of 119 studies were originally retrieved in the search. After removal of duplicates, a total of 82 articles were retrieved. Of these trials, a total of 4 studies16, 17, 18, 26 were included (fig 1), with reasons for study exclusion outlined in figure 1, and strong agreement (κ=.82) achieved between reviewers for study selection. A total of 164 participants were included, with the underlying cause of bronchiectasis reported in 1 study,¹⁶ which included idiopathic bronchiectasis and

Discussion

This systematic review included recent studies of PR or ET in individuals with non-CF bronchiectasis. Short-term benefits in endurance and functional exercise capacity, cough-related symptoms, and disease-specific HRQOL, with reductions in dyspnea and fatigue levels, were evident with supervised outpatient programs in stable patients, but improvements were not sustained beyond 3 months. This intervention did not alter anxiety or depression. For PR initiated during an exacerbation requiring

Conclusions

Programs of PR or ET initiated during the stable state have clinically significant benefits, but there appears to be no benefits if initiated during an acute exacerbation and continued beyond discharge. The improvements in exercise capacity and HRQOL are of a short duration. Further exploration to identify the effects of these interventions on disease severity and optimal approaches to maintain positive outcomes are needed.

Supplier

a.
Review Manager 5.3; Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014. Available at: http://ims.cochrane.org/revman.

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Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study
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Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging.
To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program?
Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes.
One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss.
Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear.
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Effect of exercise-based pulmonary rehabilitation in patients with bronchiectasis: A meta-analysis
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Citation Excerpt :
A total of five studies were included in this meta-analysis. The results show that pulmonary rehabilitation therapy improves exercise capacity, as measured by ISWD, in patients with bronchiectasis, which is consistent with Lee et al.’s study [23]. In our study, ISWD improved by 92.47 m after exercise training, and the difference between the two groups was statistically significant.
We aimed to assess the effectiveness of exercise training in patients with bronchiectasis in terms of exercise capacity, pulmonary function, and quality of life.
PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) examining pulmonary rehabilitation to treat bronchiectasis, and the search timeline was from inception through November 2020. Two researchers independently screened the literature, extracted data, evaluated the risk of bias in the included studies, and used Review Manager 5.3 software to perform the meta-analysis. The primary outcomes were incremental shuttle walk distance (ISWD) and 6-minute walk distance (6-MWD) at 8 weeks. The secondary outcomes were forced expiratory volume in 1 second (FEV1), St. George's Respiratory Questionnaire (SGRQ) score, and Leicester Cough Questionnaire (LCQ) score at 8 weeks.
A total of five RCTs with a total of 198 patients were included. A pooled analysis showed that improvements in ISWD (mean difference [MD] = 92.47 m, 95% confidence interval [CI] 49.87, 135.08; P < 0.0001), 6-MWD (MD = 31.01 m, 95% CI 1.60, 60.42; P = 0.04), and FEV1 (MD = 0.08 L, 95% CI 0.04, 0.12; P = 0.0002) in the pulmonary rehabilitation group were more marked than in the control group. There was no significant difference between the two groups in terms of the improvement in SGRQ and LCQ scores.
Pulmonary rehabilitation improves exercise capacity and pulmonary function (specifically FEV1) in patients with bronchiectasis. However, due to limitations in the number and quality of current studies, the above conclusions need to be verified in future research.
Respiratory Physiotherapy and Bronchiectasis
2022, Archivos de Bronconeumologia

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: Disclosures: none.

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Review article (meta-analysis)Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review

Abstract

Objective

Data Sources

Study Selection

Data Extraction

Data Synthesis

Conclusions

Section snippets

Search strategy

Results

Discussion

Conclusions

Supplier

Chest

Respir Med

Respir Med

Respir Med

Chest

Arch Bronconeumol

Respir Med

Non-cystic fibrosis bronchiectasis

Am J Respir Crit Care Med

Outcome in adult bronchiectasis

COPD

Risk factors for morbidity and death in non-cystic fibrosis bronchiectasis: a retrospective cross-sectional analysis of CT diagnosed bronchiectasis patients

Respir Res

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue and health status

Multidiscip Respir Med

Systemic comorbidities in bronchiectasis

Chron Respir Dis

Sedentary behaviour and physical activity in bronchiectasis: a cross-sectional study

BMC Pulm Med

British Thoracic Society guidelines for non-CF bronchiectasis

Thorax

Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines

Med J Aust

Pulmonary rehabilitation in patients with bronchiectasis: pulmonary function, arterial blood gases and the 6-minute walk test

J Cardiopulm Rehabil Prev

Pulmonary rehabilitation in lung disease other than chronic obstructive pulmonary disease

Am Rev Respir Dis

Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease

J Cardiopulm Rehabil Prev

Effects of pulmonary rehabilitation in bronchiectasis: a retrospective study

Chron Respir Dis

Review article (meta-analysis)
Pulmonary Rehabilitation in Individuals With Non–Cystic Fibrosis Bronchiectasis: A Systematic Review