Impact of pulmonary rehabilitation programme design on effectiveness in COPD: a systematic review and component network meta-analysis

作者：Tom Ward, Lorna E. Latimer, Enya Daynes, Suzanne C Freeman, Sarah Ward, Jiaqing Xu, Muhammed Haris, Majda Bakali, Sophie Reap, Mamoon Iqbal, Lin Wang, Akash Kamalakshan Mavilakandy, Aarinola Olaiya, Hnin Aung, Theresa C. Harvey‐Dunstan, Sally J. Singh, Neil J. Greening, Rachael A Evans, MICHAEL C. STEINER, Alex J. Sutton · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103433 · 被引用次数：9 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Meta-analysis and systematic reviews、Dysphagia Assessment and Management

Background: Pulmonary rehabilitation (PR) is a key treatment for chronic obstructive pulmonary disease (COPD) recommended by all guidelines. However, programmes vary widely and the optimal combination of components to maximise benefits and efficiency remains unknown. We aimed to use the novel technique of component network meta-analysis (cNMA) to investigate the relative contribution of 1) exercise modality and intensity, 2) non-exercise components, 3) type of supervision, and 4) programme duration of PR for people with COPD. Methods: MEDLINE, EMBASE, CINAHL, and Cochrane databases searched in October 2023 with no date or language restrictions. We included randomised controlled trials (RCTs) which included an intervention involving exercise for people with COPD. We present outcomes of exercise capacity, breathlessness and health related quality of life (HRQoL). Screening and eligibility were assessed by two independent reviewers. cNMA, a technique developed to investigate complex interventions such as PR, was conducted to examine the contribution of single components within diverse multicomponent interventions controlling for cohort demographics. PROSPERO: CRD42022322058. Findings: We included 337 RCTs with 18,911 participants and 227 intervention components. In-person supervision enhanced gains in exercise capacity (Standardised mean difference (SMD) 0.41, 95% CrI 0.20; 0.63), HRQoL (0.43 95% CrI 0.19; 0.68) and breathlessness (0.31 95% CrI 0.04; 0.58) over exercise training...