title: Pulmonary Rehabilitation as a Mechanism to Reduce Hospitalizations for Acute Exacerbations of COPD: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Acute exacerbation of COPD (AECOPD) has a significant impact on health-care use, including physician visits and hospitalizations. Previous studies and reviews have shown that pulmonary rehabilitation (PR) has many benefits, but the effect on hospitalizations for AECOPD is inconclusive.
  
  
  METHODS
  A literature search was carried out to find studies that might help determine, using a meta-analysis, the impact of PR on AECOPD, defined as unscheduled or emergency hospitalizations and ED visits. Cohort studies and randomized controlled trials (RCTs) reporting hospitalizations for AECOPD as an outcome were included. Meta-analyses compared hospitalization rates between eligible PR recipients and nonrecipients before and after rehabilitation.
  
  
  RESULTS
  Eighteen studies were included in the meta-analysis. Results from 10 RCTs showed that the control groups had a higher overall rate of hospitalization than did the PR groups (control groups: 0.97 hospitalizations/patient-year; 95% CI, 0.67-1.40; PR groups: 0.62 hospitalizations/patient-year; 95% CI, 0.33-1.16). Five studies compared admission numbers in the 12 months before and after rehabilitation, finding a significantly higher admission rate before compared with after (before: 1.24 hospitalizations/patient-year; 95% CI, 0.66-2.34; after: 0.47 hospitalizations/patient-year; 95% CI, 0.28-0.79). The pooled result of three cohort studies found that the reference group had a lower admission rate compared with the PR group (0.18 hospitalizations/patient-year; 95% CI, 0.11-0.32 for reference group vs 0.28 hospitalizations/patient-year; 95% CI, 0.25-0.32 for the PR group).
  
  
  CONCLUSIONS
  Although results from RCTs suggested that PR reduces subsequent admissions, pooled results from the cohort studies did not, likely reflecting the heterogeneous nature of individuals included in observational research and the varying standard of PR programs.
authors: Department of Respiratory Epidemiology Occupational Medicine and Public Health, Imperial College London, London, England. Electronic address: liz.moore@imperial.ac.uk.
authors: Elizabeth
authors: E
authors: Moore
authors: Department of Primary Care and Pubic Health, Imperial College London, London, England.
authors: Thomas
authors: T
authors: Palmer
authors: Department of Primary Care and Pubic Health, Imperial College London, London, England.
authors: Roger
authors: R
authors: Newson
authors: Department of Primary Care and Pubic Health, Imperial College London, London, England.
authors: Azeem
authors: A
authors: Majeed
authors: Department of Respiratory Epidemiology Occupational Medicine and Public Health, Imperial College London, London, England.
authors: Jennifer K
authors: JK
authors: Quint
authors: Department of Primary Care and Pubic Health, Imperial College London, London, England.
authors: Michael A
authors: MA
authors: Soljak
mesh_terms: D018450:Disease Progression; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012138:Respiratory Therapy / Q000379:methods*
keywords: COPD; exacerbations; hospitalizations; pulmonary; rehabilitation