Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis

Aim: Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. Design: Meta-analysis. Methods: R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I². The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. Data Sources: A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. Results: Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39–1.18), forced vital capacity (0.98; 95%CI 0.39–1.56), total lung capacity (0.83; 95%CI 0.22–1.44), 6-minute walk distance (1.56; 95%CI 1.10–2.02) and quality of life (0.99; 95%CI 0.38–1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. Conclusions: Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. Impact: These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. Implications for the profession: Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. Reporting Method: PRISMA guideline was followed. Patient or Public Contribution: No patient or public contribution.