PICOS (population, intervention, comparison, outcome, study type) table for the search strategy
| Description, inclusion | Exclusion criteria | Operational rules | |
| Population | Adults with primary diagnosis of CRDs Age >18 years Comorbidity will not be an exclusion criterion | Pregnant women and paediatric population Rehabilitation provided to predominant condition is nonrespiratory conditions Recovery from acute infections or injury (e.g. immediately post-COVID-19) until the condition has been stable for 6 months Conference abstract Lung cancer Pulmonary hypertension | PR delivered to people with CRDs such as COPD, remodelled asthma, PIAT, bronchiectasis, ILD, CF, stable post-COVID-19 (but excluding post-ICU rehabilitation) will be studied. We will also include PR delivered to people with more than one CRD, or undifferentiated chronic respiratory conditions Conference abstracts will be excluded, but will prompt a search for a subsequent published paper |
| Intervention | Home-PR that comprises both exercise and at least one nonexercise component for a duration not less than 4 weeks | Formal hospital or community medical centre-based programmes | Home-PR: the key criterion is that the sessions are undertaken by individuals by themselves (although a family member may be involved) and typically at home. Apart from baseline and post-PR assessments, the patient does not attend a centre (either a hospital centre or a local “satellite” centre) and is not supervised face-to-face by a healthcare professional (although there may be remote communication from a healthcare professional for some or all of the session), and is not part of an “in-person” group Exercise sessions typically include aerobic, endurance, resistance and reconditioning exercises, although local resources and preferences may include other exercise modalities. Nonexercise components commonly include patient education, energy conservation training, smoking cessation, psychological support, self-management skill development or other recognised PR interventions, along with optimisation of pharmacotherapy |
| Comparison | Either population receiving centre-PR or receiving usual care | No control group | Centre-PR: the key criterion is that the sessions are under direct healthcare professional's supervision. The “centre” can be in a hospital, community setting or remote facility. Centre-based sessions are normally group-based (although it is recognised that this may be modified in the context of a pandemic). Telehealth services where patients attend a supervised satellite centre would be considered as centre-PR Usual care: the standard care received by individuals with CRD in the relevant healthcare system, but excluding the exercise components of PR |
| Outcomes | Either one of the following outcome measures: HRQoL Functional exercise capacity ± Additional outcome(s): Uptake of the service, completion rates Assessment of motivation/other intermediate outcome Activities of daily living Physical activity level Symptom control Psychological status Healthcare burden, e.g. exacerbation rates, hospitalisation, etc. Adverse effect | Not including HRQoL or any measurement of exercise capacity as outcome | Any validated instruments will be considered: HRQoL: e.g. SGRQ, CRQ, EQ-5D Functional exercise capacity: e.g. 6MWT, ISWT, ESWT. We will also include step tests and sit-to-stand tests that are sometimes used in home-PR assessments Symptom control: e.g. mMRC, CCQ, Borg scale Psychological status: e.g. HADS, PHQ-9, STAI, Beck's inventory tests |
| Setting | Any settings | Low- or high-resource settings, irrespective of level of economies of the countries | |
| Study designs | RCTs, CCTs | Cohort study, case series, case report | We will exclude studies that do not have a control group. We will consider RCTs to answer all of the three research questions (i.e. effectiveness, components and completion rate of home-PR), and consider CCTs to answer research questions 2 and 3 |
| Language | No language restriction |
CRD: chronic respiratory disease; COVID-19: coronavirus disease 2019; PR: pulmonary rehabilitation; PIAT: pulmonary impairment after tuberculosis; ILD: interstitial lung disease; CF: cystic fibrosis; ICU: intensive care unit; HRQoL: health-related quality of life; SGRQ: St George's Respiratory Questionnaire; CRQ: Chronic Respiratory Questionnaire; EQ-5D: EuroQol Five Dimension; 6MWT: 6-min walk test; ISWT: incremental shuttle walking test; ESWT: endurance shuttle walking test; mMRC: modified Medical Research Council dyspnoea scale; CCQ: Clinical COPD Questionnaire; HADS: Hospital Anxiety and Depression Scale; PHQ-9: Patient Health Questionnaire-9; STAI: State-Trait Anxiety Inventory; RCT: randomised controlled trial; CCT: clinical controlled trial. Reproduced from [36] with permission.