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A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence

¹ Departments of Pneumology and Respiratory Rehabilitation, University Hospital Leuven, Leuven, Belgium
² Centre for Evidence Based Physiotherapy, Department of Epidemiology and Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
³ Departamento de Fisioterapia, Universidade Norte do Paraná-UNOPAR, Londrina, Brazil
⁴ Research and Innovation Group in Health Care and Nursing, Hanze University, Applied Sciences, Groningen, The Netherlands
⁵ Department of Physical Therapy, Erasmus Medical Centre, Rotterdam, The Netherlands
⁶ Physical Therapy Practice Verhoef Utrecht, Utrecht, The Netherlands
⁷ Hogeschool Leiden, University of Applied Sciences, Leiden, Free University Medical Centre Amsterdam, Amsterdam, The Netherlands
⁸ University Lung Centre Dekkerswald, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
⁹ Department of Pneumology, CHU Saint-Pierre, ULB (Université Libre de Bruxelles), Brussels, Belgium
¹⁰ Department of Pneumology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
¹¹ Research Institute CAPHRI, Department of General Practice, Maastricht University, Maastricht, The Netherlands

^* To whom correspondence should be addressed. E-mail: Rik.Gosselink{at}faber.kuleuven.be.

	Abstract

Purpose: Update of a clinical practice guideline for the physiotherapy management of patients with chronic obstructive pulmonary disease supporting the clinical decision-making process.

Methods: A systematic computerized literature search was performed on different modalities for improving physical exercise capacity, reducing exertional dyspnoea, improving airway clearance and encouraging changes in physical activity behaviour. Methodological quality was scored with the PEDro Scale. Scientific conclusions were graded according to the criteria of the ‘Dutch Evidence Based Guideline Development Platform’. These, together with practical considerations, were used to formulate recommendations for clinical practice.

Results: A total of 103 studies were included in the systematic review, consisting of five meta-analyses of randomized controlled trials, 84 randomized controlled trials and 14 uncontrolled studies. Twenty scientific conclusions supported six recommendations on physical exercise training. Nineteen scientific conclusions supported eight recommendations on interventions for reducing dyspnoea. Five scientific conclusions supported seven recommendations concerning treatment modalities to improve mucus clearance, and two scientific conclusions supported two recommendations on strategies for encouraging permanent changes in physical activity behaviour.

Conclusions: Strong recommendations support the use of physical exercise training to improve health-related quality of life and functional exercise capacity. Future research should investigate whether additional interventions for reducing exertional dyspnoea have a place as adjuncts to physical exercise training in selected patients. In addition, treatment of impaired mucus clearance, especially during acute exacerbations, requires further research. With the advance of new technologies for objective measurements of physical activities in daily life more research is needed concerning interventions to initiate and maintain physical activity behaviour change during and after supervised physical exercise training programmes

First published on April 23, 2009, doi:10.1177/0269215509103507

Clinical Rehabilitation 2009;23:445.

A more recent version of this article appeared on May 1, 2009


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