Evidence map›Paper›PMID 30219047›Full record

SynthesisBMC pulmonary medicine2018

Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis.

Camilla Koch Ryrsø, Nina Skavlan Godtfredsen, Linette Marie Kofod, Marie Lavesen, Line Mogensen, Randi Tobberup, Ingeborg Farver-Vestergaard, Henriette Edemann Callesen, Britta Tendal, Peter Lange and 1 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC pulmonary medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
99citing papers in PubMed, 14 pooled it
9.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

99 citing papers in PubMed, 14 syntheses or guidelines pooled it, 178 citations in OpenAlex.

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  11. Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review.International journal of chronic obstructive pulmonary disease · 2022
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  17. Effects of an early rehabilitation program for adult cystic fibrosis patients during hospitalization: a randomized clinical trial.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologica · 2023
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39 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Camilla Koch RyrsøThe Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. camilla.koch.ryrsoe@regionh.dk.ORCID http://orcid.org/0000-0002-8059-7331
Nina Skavlan GodtfredsenDepartment of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark.
Linette Marie KofodDepartment of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark.
Marie LavesenDepartment of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark.
Line MogensenThe Department of the Elderly and Disabled, Odense Municipality, Odense, Denmark.
Randi TobberupDepartment of Gastroenterology, Center for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark.
Ingeborg Farver-VestergaardUnit for Psychooncology and Health Psychology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Henriette Edemann CallesenDanish Health Authority, Copenhagen, Denmark.
Britta TendalDanish Health Authority, Copenhagen, Denmark.
Peter LangeThe Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
Ulrik Winning IepsenThe Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
University of Copenhagen · DKCopenhagen University Hospital · DKDanish Business Authority · DKAalborg University Hospital · DKAarhus University Hospital · DKOdense Municipality · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPulmonary rehabilitation (PR), delivered as a supervised multidisciplinary program including exercise training, is one of the cornerstones in the chronic obstructive pulmonary disease (COPD) management. We performed a systematic review and meta-analysis to assess the effect on mortality of a supervised early PR program, initiated during or within 4 weeks after hospitalization with an acute exacerbation of COPD compared with usual post-exacerbation care or no PR program. Secondary outcomes were days in hospital, COPD related readmissions, health-related quality of life (HRQoL), exercise capacity (walking distance), activities of daily living (ADL), fall risk and drop-out rate.

methodsWe identified randomized trials through a systematic search using MEDLINE, EMBASE and Cocharne Library and other sources through October 2017. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using the Cochrane Risk of Bias tool.

resultsWe included 13 randomized trials (801 participants). Our meta-analyses showed a clinically relevant reduction in mortality after early PR (4 trials, 319 patients; RR = 0.58 (95% CI: [0.35 to 0.98])) and at the longest follow-up (3 trials, 127 patients; RR = 0.55 (95% CI: [0.12 to 2.57])). Early PR reduced number of days in hospital by 4.27 days (1 trial, 180 patients; 95% CI: [- 6.85 to - 1.69]) and hospital readmissions (6 trials, 319 patients; RR = 0.47 (95% CI: [0.29 to 0.75])). Moreover, early PR improved HRQoL and walking distance, and did not affect drop-out rate. Several of the trials had unclear risk of bias in regard to the randomization and blinding, for some outcome there was also a lack of power.

conclusionModerate quality of evidence showed reductions in mortality, number of days in hospital and number of readmissions after early PR in patients hospitalized with a COPD exacerbation. Long-term effects on mortality were not statistically significant, but improvements in HRQoL and exercise capacity appeared to be maintained for at least 12 months. Therefore, we recommend early supervised PR to patients with COPD-related exacerbations. PR should be initiated during hospital admission or within 4 weeks after hospital discharge.

Indexed as

Activities of Daily LivingDisease ProgressionExercise ToleranceHumansPatient ReadmissionPulmonary Disease, Chronic ObstructiveQuality of LifeRandomized Controlled Trials as TopicChronic obstructive pulmonary diseaseExacerbation of COPDHospital readmissionsMortalitySupervised early pulmonary rehabilitationSystematic review

Identifiers

PMID30219047
PMCPMC6139159
OpenAlexW2890788567

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.