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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 [with consumer summary]
Ahmed I, Mustafaoglu R, Yeldan I, Yasaci Z, Erhan B
Archives of Physical Medicine and Rehabilitation 2022 Jul;103(10):2051-2062
systematic review

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 two 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 < 0.001)) and exercise capacity (MD 65.85 m (95% CI 42.86 to 88.83, p < 0.001)) 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 < 0.05)) and lung functions (MD 0.26 L (95% CI 0.04 to 0.48, p < 0.05)) 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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