Figures
- FIGURE 1
Flow diagram of study selection. #: some studies excluded for multiple reasons.
Tables
- TABLE 1
Characteristics of included studies
Study (country) Study design Participants Intervention Comparison Outcomes Ringbaek et al. [21] (Denmark) Quasi-randomised trial (allocation by alternation) Intervention: 46 participants, age 68±9 years, 55% male, BMI 24±5 kg·m−2, FEV1 31±9% predicted, current smokers 14%, long-term oxygen therapy 7%, CAT score 20±7, MRC dyspnoea score 4 (2–5).
Control: 69 participants, age 69±11 years, 39% male, BMI 25±6 kg·m−2, FEV1 35±11% predicted, current smokers 17%, long-term oxygen therapy 13%, CAT score 19±6, MRC dyspnoea score 4 (2–5).Use of a wireless tablet computer (Nexus 7) with mobile-based internet connectivity plus usual care. The tablet software consisted of 1) a training diary (including the type, frequency, duration of exercises, and registered dyspnoea after each exercise using the Borg dyspnoea score), 2) video recordings of all the training exercises used and 3) training results for patients to monitor their own training. Staff had access to this information, and used it discuss progress, individual barriers and opportunities as well as to encourage further training. Usual care: pulmonary rehabilitation twice weekly for 7 weeks at one of two hospitals (Gentofte Hospital and Hvidovre Hospital) or 10 weeks at Nordsjælland Hospital with each session lasting 2 h. Each session consisted of 1 h of supervised exercise and 1 h of education. The supervised training sessions consisted of walking and cycling. Patients were instructed to exercise at a level equal to 85% of predicted peak oxygen uptake as calculated from the incremental shuttle walk test. Dropout rates. 1) Completion of rehabilitation: intervention 42 out of 46 participants; control 57 out of 69 participants. 2) Sessions attended: intervention 631 out of 784 sessions; control 509 out of 724 sessions. Data are presented as mean±sd or mean (range), unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; CAT: COPD Assessment Test; MRC: Medical Research Council.
- TABLE 2
Risk of bias of the included study [21]
Authors’ judgement Support for judgement Random sequence generation Inadequate Allocated by alternation Allocation concealment Inadequate No concealment Blind outcome assessment Inadequate No blinding Incomplete outcome data Adequate All participants who commenced the study are accounted for Selective reporting (reporting bias) Adequate Data for all primary and secondary measures (detailed in the methods) has been reported Other bias Inadequate Percentage predicted forced expiratory volume in 1 s was lower in the intervention group and fewer patients started pulmonary rehabilitation in the winter than in the control group. These covariates were reported as not being associated with outcomes but data was not provided. Pulmonary rehabilitation did not deliver similar improvements in routine clinical outcome measures between groups Overall risk of bias High More than one criterion deemed inadequate - TABLE 3
Characteristics of ongoing studies
Study name or title Chief investigator Study period (start and end dates) (country) Study design Participants Intervention Comparison Outcomes Pulmonary Rehabilitation and ACTIvity after COPD Exacerbations: the PRACTICE trial: a randomised trial [24] R. Hughes January 2015 to December 2016 (UK) Parallel group, randomised pilot 2×2 trial 76 participants with clinically identified exacerbation of diagnosed COPD 1) In-hospital exercise training followed by in-home post-discharge early rehabilitation; 2) standard in-hospital care followed by in-home post-discharge early rehabilitation 1) In-hospital exercise training followed by standard discharge care; 2) standard in-hospital care followed by standard discharge Subsequent uptake, adherence and completion of group-based community pulmonary rehabilitation Video to Increase RehabiliTation Uptake following hospitalised Exacerbations of COPD (VIRTUE): a randomised controlled trial [25] W. Man January 2015 to January 2017 (UK) Parallel group, randomised trial 200 adults aged >40 years diagnosed with COPD, admitted to hospital with acute exacerbation of COPD and fit enough to take part in pulmonary rehabilitation Participants will be asked to watch a 5-min patient-designed video promoting early pulmonary rehabilitation plus usual care Usual care: provided with standard verbal information and an A5 patient information leaflet about early pulmonary rehabilitation Uptake, adherence and completion of post-exacerbation pulmonary rehabilitation A tailored, psychological intervention for mild to moderate anxiety or depression in people with COPD: Tailored intervention for ANxiety and DEpression Management in COPD (TANDEM) [26] S. Taylor April 2016 to January 2021 (UK) Three-phase study (phase I: preparation; phase II: pilot randomised controlled trial; phase III: a fully powered individually randomised controlled trial) Adults with moderate–severe COPD with mild–moderate comorbid anxiety or depression and eligible for attendance at their local pulmonary rehabilitation; phase II: 45 participants; phase III: 430 participants Tailored, one-to-one psychological intervention combined with practical problem-solving components based on: Self-management Programme of Activity Coping and Education (SPACE) and The Lung Manual, a nurse-led intervention based on cognitive behavioural principles and self-management, and developed to address mood disorders of anxiety in COPD; this psychological intervention links into, and interdigitates with, usual pulmonary rehabilitation, but is independent of it Usual care: standard pulmonary rehabilitation without interdigitating psychological intervention Uptake and completion of pulmonary rehabilitation (to be informed by the pre-pilot and pilot studies) COPD: chronic obstructive pulmonary disease.
Supplementary Material
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Supplementary material 00089-2016_supp
Vol 3 Issue 1
Table of Contents
Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD
