Table 4 PICOS search strategy.
PICOS | Description, inclusion/exclusion criteria | Operational rules |
|---|---|---|
Population | Adults with CRDs. Comorbidity was not an exclusion criterion. No age restrictions | Any CRD (COPD, post TB, remodelled asthma, bronchiectasis, interstitial lung disease) or poorly differentiated respiratory conditions that cause chronic symptoms. We excluded studies that included non-respiratory causes for symptoms |
Intervention | Pulmonary rehabilitation (PR), which comprised both exercise AND at least one non-exercise component | Non-exercise components included recognised PR interventions, such as patient education, breathing exercises, energy conservation training, self-management skill development We included optimisation of pharmacotherapy as a component because in low-resource settings this may not be accessed/provided elsewhere |
Comparison | Population who are not given PR | Individuals received usual care as normal in the setting |
Outcomes | Primary outcomes: • Functional exercise capacity • Health-related quality of life (HRQoL) Secondary outcomes: • Symptom control • Psychological status • Uptake of the service, completion rates • Adverse effects | Validated instruments considered: Functional exercise capacity: 6-Minute Walk Test, Endurance Shuttle Walking Test HRQoL: SGRQ, CRQ, SF-36, SF-12, EQ-5D Symptom control: mMRC, Borg scale Psychological status: HADS, PHQ-9, STAI, Beck Inventory test Non-validated instruments were extracted, but evidence noted as being less reliable |
Setting | Low-resource settings Typically characterised by a lack of funds leading to: • Limited access to medication, equipment • Poorly developed infrastructure • Few trained personnel • Limited access to routine care | In practice, this decision was normally based on the World Bank category of a LMIC country at the time of the study. However, while low resource settings were usually in LMICs, PR delivered in a well-resourced context (e.g. a tertiary care hospital) in an LMIC would be excluded, and interventions in HICs might be included if the context was low resource (e.g. remote, deprived community) |
Study designs | Randomised controlled trials (RCTs); clinical controlled trials | We excluded studies that did not have a control group |
