Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Research Question
- “PICOS”
- P (Population) = COVID-19 patients
- I (Intervention) = respiratory rehabilitation
- C (Comparison) = standard treatment
- O (Outcome) = physical function and quality of life
- S (Study design) = randomized controlled trial, and controlled clinical studies.
2.3. Types of Outcome Measures
2.3.1. Primary Outcomes
- Physical function.
- Quality of life.
2.3.2. Secondary Outcomes
- 3.
- Dyspnoea.
- 4.
- Respiratory function.
- 5.
- Physical activity intensity level.
- 6.
- Anxiety.
- 7.
- Depression.
- 8.
- Peripheral muscle performance of lower limbs.
2.4. Data Sources
2.5. Eligibility Criteria
2.5.1. Inclusion Criteria
- 9.
- Unvaccinated COVID-19 patients with no age limit.
- 10.
- Publications with no language limitation and with full text available.
- 11.
- Pulmonary rehabilitation.
- 12.
- Randomized controlled trials, and controlled clinical studies.
2.5.2. Exclusion Criteria
2.6. Study Selection
2.7. Data Extraction
2.8. Assessment of Risk of Bias
2.9. Analysis
2.9.1. Measurement of Treatment Effect
2.9.2. Sensitivity Analysis
2.9.3. Summary of Findings Table
- Key findings that were summarized (participants, comparative and baseline data, and results) [22].
- Statistical results that have been condensed.
- A summary of the evidence’s quality, the degree of the effect, and the source of information utilized in the assumed risk.
3. Results
3.1. Included Studies
3.2. Participants
3.3. Intervention
3.4. Comparison
3.5. Excluded Studies
3.6. Risk of Bias in Included Studies
3.6.1. Random Sequence and Allocation Concealment
3.6.2. Blinding of Participants, Personnel, and Outcome Assessment
3.6.3. Incomplete Outcome Data
3.6.4. Selective Reporting
3.6.5. Other Potential Sources of Bias
3.7. Outcomes
3.7.1. Primary Outcomes
Physical Function
Quality of Life
3.7.2. Secondary Outcomes
Depression
Anxiety
Dyspnoea
Physical Activity Intensity Level
Peripheral Muscle Performance of Lower Limbs
Pulmonary Function
Sleep Quality
Social Support
4. Discussion
4.1. Summary of Main Results
4.2. Overall Completeness and Applicability of Evidence
4.3. Quality of the Evidence
4.4. Potential Biases in the Review Process
4.5. Limitation of the Study
4.6. Agreements and Disagreements with Other Studies or Reviews
5. Conclusions
5.1. Implications for Practice
5.2. Implications for Research
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Reference | Journal | Population | Year of Publication | Sample Size (F) | Participants/Age | Period of Recruitment | Gender | Method (Exercise Name, Duration, Intensity, Sets, Reps). | Status of the Patient at Intervention | Duration of Intervention | Outcome Measures | PRO Measure Instrument |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. [17] | Complementary Therapies in Clinical Practice | China | 2020 | 72 EX = 36 CO = 36 | Elderly patients with COVID-19. 69.4 ± 8.0 | 1 January 2020 to 6 February 2020 | Male | Participant subjected to pulmonary rehabilitation of two S/W for ten M. The intervention includes respiratory muscle EX, cough EX, diaphragmatic EX: stretching EX at 60% of the individual’s maximal expiratory mouth pressure. While the CO received only standard treatment | Definite diagnosis of COVID-19 | Six W | 1. PFT 2. functional tests 3. QOL 4. Activities of daily living 5. Mental status tests. | 1. Spirometer 2. 6MWT 3. SF-36 4. FIM scores 5. SAS anxiety and SDS depression scores |
2. [26] | Frontiers in Psychiatry | China | 2020 | 16 EX = 13 CO = 13 | COVID-19 patients 49.98 ± 13.73 | 23 February 2020 to 13 March 2020 | Male and female | Patients undergo breathing exercises for 20 M every D, to stimulate nasal and diaphragmatic breathing, increase expiratory duration, reduce respiratory flow, and regulate breathing rhythm + psychological support The CO received only Standard treatment | Definite diagnosis of COVID-19 | 10 D | 1. Depression and anxiety, 2. Social support | 1. HADS-A and HADS-D 2. PSSS |
3. [23] | International Journal of Environmental Research and Public Health | Spain | 2021 | 38 Ex = 19 Co = 19 | Mild to moderate symptomatology in the acute stage COVID-19 patients 40.79 ± 9.84 | 19 October 2020 | Male and female | Respiratory telerehabilitation programme, the breathing EX was once /D for seven D at home; based on the assessment of the RPE, patients underwent four RPE on a scale of seven-ten for ten M). The CO received only Standard treatment | Confined COVID-19 Patients in the Acute Phase | One W | 1. Physical function 2. Peripheral muscle performance of lower limbs 3. Multidimensional nature of dyspnoea 4. Physical activity intensity level | 1. 6MWT 2. Thirty-Second STST 3. Multidimensional Dyspnoea-12 4. RPE |
4. [27] | Psychology, Health & Medicine | China | 2021 | 140 Ex = 70 Co = 70 | patients with mild COVID-19 infections All age group | In March 2020 | Male and female | Pulmonary rehabilitation included Five-tone breathing EX, five-step breathing EX and two-section motion E, for seven D. The CO received only Standard treatment | Definite diagnosis of COVID-19 | One W | 1. Anxiety state 2. Sleep quality | 1. SAI 2. PQSI |
5. [24] | Medicine | Spain | 2021 | 36 EX = 18, CO = 18 | COVID-19 patients with mild to moderate symptomatology 39.39 ± 1174 | 23 October 2020 | Telerehabilitation programme included ten EX based on non-specific toning EX of resistance and strength one/D for seven D using the RPE scale to determine EX intensity. The CO received only Standard treatment | Confined COVID-19 Patients in the Acute Phase | One W | 1. Physical function 2. Peripheral muscle performance of lower limbs. 3. Physical activity intensity level | 1. 6MWT 2. 30STST 3. RPE | |
6. [25] | Rehabilitation | China | 2021 | 120 EX = 59 CO = 61 | Hospitalized COVID-19 survivors with remaining dyspnoea 49.17 ± 10.75 | 28 May 2020 | Male and female | Participants were subjected to six W of unsupervised home EX programme for three-four S/W. Ex includes: -breathing control and thoracic expansion. The CO received only Standard treatment | In post-discharge COCID-19 patients | six W | 1. Physical function, 2. Peripheral muscle performance of lower limp 3. Pulmonary function, 4. QOL 5. Dyspnoea | 1. 6MWT 2. squat time in seconds 3. Spirometer 4. HRQOL12 5. mMRC dyspnoea |
Outcome | Certainty Assessment | № of Patients | Effect | Certainty | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
№ of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | Respiratory Rehabilitation | Standard Treatment | Absolute (95% CI) | ||
Physical function | 4 | RCT | serious b | serious c | not serious | serious a | none | 132 | 134 | SMD 0.83. higher (0.58 higher to 1.09 higher) | ⨁◯◯◯ Very low |
Physical-health-related quality of life. | 2 | RCT | serious b | serious d | not serious | serious a | none | 95 | 96 | SMD 0.02 higher (0.57 lower to 0.62 higher) | ⨁◯◯◯ Very low |
Mental-health-related quality of life | 2 | RCT | serious b | serious c | not serious | serious a | none | 95 | 96 | SMD 0.06 lower (0.51 lower to 0.40 higher) | ⨁◯◯◯ Very low |
Depression | 2 | RCT | serious f | serious d | not serious | serious a | none | 49 | 49 | SMD 0.16 SD higher (0.66 lower to 0.97 higher) | ⨁◯◯◯ Very low |
Anxiety | 3 | RCT | serious b | not serious | not serious | serious a | none | 119 | 119 | SMD 0.8 lower (1.23 lower to 0.37 lower) | ⨁⨁◯◯ Low |
Dyspnoea | 2 | RCT | not serious | not serious | not serious | serious a | none | 78 | 79 | SMD 0.55 lower (0.87 lower to 0.23 lower) | ⨁⨁⨁◯ Moderate |
Physical activity intensity level | 2 | RCT | not serious | serious d | not serious | serious a | none | 37 | 37 | SMD 1.27 lower (2.23 lower to 0.32 lower) | ⨁⨁◯◯ Low |
Peripheral muscle performance of lower limp | 3 | RCT | not serious | not serious | not serious | serious a | none | 96 | 97 | SMD 0.9 higher (0.6 higher to 1.2 higher) | ⨁⨁⨁◯ Moderate |
Pulmonary function | 2 | RCT | serious b | very serious e | not serious | serious a | none | 95 | 96 | SMD 1.92 lower (5.8 lower to 1.97 higher) | ⨁◯◯◯ Very low |
Sleep quality | 1 | RCT | serious g | not serious | not serious | serious a | none | 70 | 70 | MD 0.5 lower (0.83 lower to 0.16 lower) | ⨁⨁◯◯ Low |
Social support | 2 | RCT | serious b | serious e | not serious | serious a | none | 49 | 49 | SMD 0.79 higher (0.94 lower to 2.53 higher) | ⨁◯◯◯ Very low |
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AL-Mhanna, S.B.; Mohamed, M.; Noor, N.M.; Afolabi, H.A.; Irekeola, A.A.; Bello, K.E.; Aldhahi, M.I.; Wan Ghazali, W.S. Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis. Healthcare 2022, 10, 2130. https://doi.org/10.3390/healthcare10112130
AL-Mhanna SB, Mohamed M, Noor NM, Afolabi HA, Irekeola AA, Bello KE, Aldhahi MI, Wan Ghazali WS. Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis. Healthcare. 2022; 10(11):2130. https://doi.org/10.3390/healthcare10112130
Chicago/Turabian StyleAL-Mhanna, Sameer Badri, Mahaneem Mohamed, Norhayati Mohd Noor, Hafeez Abiola Afolabi, Ahmad Adebayo Irekeola, Kizito Eneye Bello, Monira I. Aldhahi, and Wan Syaheedah Wan Ghazali. 2022. "Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis" Healthcare 10, no. 11: 2130. https://doi.org/10.3390/healthcare10112130
APA StyleAL-Mhanna, S. B., Mohamed, M., Noor, N. M., Afolabi, H. A., Irekeola, A. A., Bello, K. E., Aldhahi, M. I., & Wan Ghazali, W. S. (2022). Effectiveness of Pulmonary Rehabilitation among COVID-19 Patients: A Systematic Review and Meta-Analysis. Healthcare, 10(11), 2130. https://doi.org/10.3390/healthcare10112130