Table 1 PICOS table for the search strategy

Population

Adults with chronic respiratory disease (CRD), including undiagnosed conditions that cause chronic respiratory symptoms. Although most literature from high-income countries is disease specific (typically COPD)⁴⁰ in low-resource settings we anticipate a broader range of diseases and potentially undifferentiated CRD (e.g., COPD, post TB, remodelled asthma, bronchiectasis, interstitial lung disease⁴¹)

Comorbidity will not be an exclusion criterion

Intervention

Pulmonary rehabilitation (PR), which includes exercise training (typically aerobic, resistance, and reconditioning,¹¹ though local resources and preferences may include other exercise modalities,⁴²) and at least one of the following components:^16,43 patient education, breathing exercises, energy conservation training, peer group interaction, self-management skill development or other recognised PR interventions along with optimisation of pharmacotherapy

Studies of cardio-pulmonary rehabilitation will be included only if data relating to patients with respiratory disease can be extracted

Comparator

Population who are not given PR—typically ‘usual care’

Outcomes of interest

Primary outcomes will be:

• Functional exercise capacity (e.g., 6-Minute Walk Test, Incremental Shuttle Walking Test, Endurance Shuttle Walking Test)

• Health-Related Quality of Life (HRQoL) (e.g., St. Georges Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ)

Secondary outcomes will be

• Symptom control: e.g., CCQ; including measures of breathlessness: e.g., MRC Dyspneoa Score, Borg scale

• Psychological status, e.g., HADS, PHQ-9

• Health-care burden, e.g., exacerbation rates, hospitalisation etc.

• Uptake of the service, completion rates

• Adverse effects

Setting

Low-resource settings⁴⁴ typically characterised by lack of funds to cover health-care costs, on individual or societal basis, which leads to one or all of the following:

• Limited access to medication, equipment, supplies, devices

• Less‐developed infrastructure (electrical power, transportation, controlled environment/buildings)

• Fewer or less‐trained personnel

• Limited access to maintenance and parts

• Limited availability of equipment, supplies and medication

While low-resource settings will often be in LMICs, we will specifically exclude PR delivered in a well-resourced context (e.g., a tertiary care hospital) in an LMIC, and may include interventions in high-income countries if the context is low resource (e.g., remote, deprived community)

Study designs

Randomised control trials (RCTs) and clinical controlled trials