THE IMPACT OF HOME-BASED PHYSIOTHERAPY INTERVENTIONS ON BREATHLESSNESS DURING ACTIVITIES OF DAILY LIVING IN SEVERE COPD ¨C A SYSTEMATIC REVIEW
Martin Thomas* Janet Simpson** Richard Riley*** Emily Grant**
*NHS Halton and St Helens Research and Development Department Suite 1, Unit 1 H Midwood House Midwood Street Widnes WA8 6BH **University of Liverpool Directorate of Physiotherapy The Quadrangle Brownlow Hill Liverpool England L69 3BG ***Centre for Medical Statistics and Health Evaluation School of Health Sciences University of Liverpool Shelly¡¯s Cottage Brownlow Street Liverpool England L69 3GS
Objectives: Systematic review and meta-analysis to determine the impact of home-based physiotherapy interventions on breathlessness during activities of daily living (ADL) in severe COPD. Data sources: Electronic databases AMED, CINAHL, Cochrane collaboration database, EMBASE, MEDLINE and PEDro were searched from inception to May 2008. Bibliographies of potentially relevant retrieved studies, identified relevant systematic reviews and international guidelines were hand searched. Methods: Inclusion criteria were adults over 18 years with severe COPD defined as FEV1 ¡Ü50% predicted without cardiovascular co-morbidities, home-based interventions and valid, reliable breathlessness ADL outcomes measures. The PEDro scale assessed methodological quality. Data extraction included baseline characteristics, treatment intervention, frequency of training, level of supervision, breathlessness ADL outcome measure and results. Where possible, a random-effects meta-analysis was applied to appropriate trial data to produce overall quantitative results. Results: Seven studies, providing 9 data sets, met inclusion criteria. Trial PEDro scores ranged from 4-7/10. Studies were homogenous at baseline regarding age and COPD severity, although predominantly male. Five studies investigated inspiratory or expiratory muscle training (IMT, EMT) and 2 investigated exercises. Statistically significant breathlessness ADL outcome improvements were found for all interventions expect EMT. Five demonstrated clinical significance, 4 IMT and 1 exercise. Three IMT studies provided sufficient data for meta-analysis, and the pooled result indicates IMT improves breathlessness score by 2.36 (95% CI 0.76-3.96) compared to control. Conclusion: IMT and exercise are cost-effective home-based physiotherapy interventions that can improve breathlessness during ADL in severe COPD; IMT being better substantiated. Administration is advocated in outpatient services and primary care.
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