AIM: To assess the efficacy of a rehabilitation programme for patients with chronic obstructive pulmonary (COPD). METHOD: A systematic review of randomized clinical trials (RCT's) was carried out. To this end, a computer-aided and manual search for published RCT's investigating the efficacy of multifaceted rehabilitation in patients with COPD was performed. The methodological quality of the included trials was assessed by two independent reviewers, using a list of 10 criteria (maximum score: 10 points) based on generally accepted principles of intervention research. A study was considered of sufficient methodological quality when it scored more than 5 points. Only the RCT's of sufficient methodological quality were included in the analysis. RESULTS: The methodological quality of the studies included was average (median 5.5, range 3.5 to 7.5). Eleven of 19 RCT's were of sufficient quality. The most common methodological flaws concerned sample size, prestratification, drop-outs, and blinding. Seven RCT's used walking distance and maximum exercise capacity as outcome measures. Five and four of these studies support the efficacy of a rehabilitation programme, respectively. Six of the eight studies using functional exercise capacity showed a positive result of exercise training. Rehabilitation resulted in a decrease in dyspnoea, as determined with the Chronic Respiratory Disease Questionnaire (CRDQ). Four studies used the other dimensions of the CRDQ to measure quality of life. all four studies show an improved score (a beneficial effect) on the mastery scale. Two of four studies showed improved scores on the fatigue scale and two other studies showed improved scores on the emotional function scale. CONCLUSION: The most important findings of this systematic review are that rehabilitation programmes can improve functional exercise capacity (walking distance and endurance time on a bicycle ergometer) and quality of life (dyspnoea and mastery dimension of the CRDQ) of patients with COPD. the effect on maximum exercise capacity are more equivocal. Future studies should address the lack of methodolgical quality of individual studies, the relative efficacy of the various components of rehabilitation, and the long-term effects of rehabilitation programmes.

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