title: Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To develop a meta-analysis to determine the effectiveness of rehabilitation in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  medline, cinhal, and Cochrane Library searches for trials of rehabilitation for COPD patients. Abstracts presented at national meetings and the reference lists of pertinent articles were reviewed.
  
  
  METHODS
  Studies were included if: trials were randomized; patients were symptomatic with forced expiratory volume in one second (FEV1) <70% or FEV1 divided by forced vital capacity (FEV1/FVC) <70% predicted; rehabilitation group received at least 4 weeks of rehabilitation; control group received no rehabilitation; and outcome measures included exercise capacity or shortness of breath. We identified 69 trials, of which 20 trials were included in the final analysis.
  
  
  METHODS
  Effect of rehabilitation was calculated as the standardized effect size (ES) using random effects estimation techniques.
  
  
  RESULTS
  The rehabilitation groups of 20 trials (979 patients) did significantly better than control groups on walking test (ES = 0.71; 95% confidence interval [95% CI], 0.43 to 0.99). The rehabilitation groups of 12 trials (723 patients) that used the Chronic Respiratory Disease Questionnaire had less shortness of breath than did the control groups (ES = 0.62; 95% CI, 0.35 to 0.89). Trials that used respiratory muscle training only showed no significant difference between rehabilitation and control groups, whereas trials that used at least lower-extremity training showed that rehabilitation groups did significantly better than control groups on walking test and shortness of breath. Trials that included severe COPD patients showed that rehabilitation groups did significantly better than control groups only when the rehabilitation programs were 6 months or longer. Trials that included mild/moderate COPD patients showed that rehabilitation groups did significantly better than control groups with both short- and long-term rehabilitation programs.
  
  
  CONCLUSIONS
  COPD patients who receive rehabilitation have a better exercise capacity and they experience less shortness of breath than patients who do not receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. Patients with mild/moderate COPD benefit from short- and long-term rehabilitation, whereas patients with severe COPD may benefit from rehabilitation programs of at least 6 months.
authors.affiliation: University of Kansas Medical Center School of Medicine, Kansas City, Kan, USA. gsalman@adclinic.com
authors.forename: Ghassan F
authors.initials: GF
authors.lastname: Salman
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mosier
authors.forename: Brent W
authors.initials: BW
authors.lastname: Beasley
authors.forename: David R
authors.initials: DR
authors.lastname: Calkins
mesh_terms: D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D017079:Exercise Tolerance; D005541:Forced Expiratory Volume; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D012046:Rehabilitation / Q000379:methods; D016138:Walking