The influence of comorbidities on outcomes of pulmonary rehabilitation programs in patients with COPD: a systematic review.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is associated with comorbidities such as cardiovascular disease, metabolic disease, osteoporosis, and anxiety and/or depression. Although pulmonary rehabilitation programs are proven to be beneficial in patients with COPD, it is unclear whether comorbidities influence pulmonary rehabilitation outcomes. The aim of the present review was to investigate to what extent the presence of comorbidities can affect pulmonary rehabilitation outcomes.


METHODS
The systematic literature search (Pubmed, EMBASE, and PEDro) resulted in 4 articles meeting the inclusion criteria. The odds ratios (95% confidence intervals) of the logistic regression analyses, with comorbidities as independent variables and pulmonary rehabilitation outcomes (dyspnea, functional exercise capacity, and quality of life) as dependent variables, were used for data extraction.


RESULTS
Patients with anxiety and/or depression less likely improve in dyspnea. Osteoporosis is associated with less improvements in functional exercise capacity, while cardiovascular disease does not seem to negatively impact on this outcome. Patients with cardiovascular comorbidity will experience less positive changes in quality of life.


CONCLUSIONS
Evidence from literature suggests that comorbidities can have a negative influence on pulmonary rehabilitation outcomes. Screening for comorbidities in pulmonary rehabilitation settings seems useful to readdress the right patients for individually tailored pulmonary rehabilitation.
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium ; Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Miek
M
Hornikx
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium ; Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Hans
H
Van Remoortel
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium ; Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Heleen
H
Demeyer
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium ; Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Carlos Augusto
CA
Marcal Camillo
Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Marc
M
Decramer
Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Wim
W
Janssens
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium ; Respiratory Division and Rehabilitation, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Thierry
T
Troosters
D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000150:complications / Q000473:pathology*; D015897:Comorbidity; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology* / Q000534:rehabilitation; D011788:Quality of Life; D016896:Treatment Outcome