Effects of external diaphragm pacing combined with conventional rehabilitation therapies in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

IF 3.3 3区 医学 Q2 RESPIRATORY SYSTEM
Linhong Jiang, Pingping Sun, Peijun Li, Weibing Wu, Zhenwei Wang, Xiaodan Liu
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引用次数: 0

Abstract

Background: Numerous randomized controlled trials (RCTs) have reported the benefits of external diaphragm pacing combined with conventional rehabilitation therapies (EDP-CRTs) on pulmonary function and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). However, evidence-based regarding its effects remains unclear.

Objectives: This systematic review and meta-analysis aimed to evaluate the effects of EDP-CRTs versus CRTs on patients with COPD.

Design: Systematic review and meta-analysis.

Data sources and methods: We performed a systematic review and meta-analysis, searching PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, China Biology Medicine Disc, Chinese National Knowledge Infrastructure, Wan-Fang Database, and Chinese Scientific Journal Database from inception to 10 September 2023. RCTs investigating the effects of EDP-CRTs versus CRTs on COPD patients were included. The primary outcome was pulmonary function, including forced expiratory volume in 1 s (FEV1), the percentage of predicted values of FEV1 (FEV1%pred), and FEV1/forced vital capacity (FVC)%. Secondary outcomes included arterial blood gas analysis [the partial pressure of arterial oxygen (PaO2) and the partial pressure of arterial carbon dioxide (PaCO2)]; dyspnea [modified Medical Research Council Dyspnea Scale (mMRC)]; exercise capacity [6-min walking distance (6MWD)]; and quality of life [COPD assessment test (CAT)]. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0). The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system.

Results: In total, 13 studies/981 participants were included. The pooled results revealed significant benefits of EDP-CRTs versus CRTs on the FEV1 [standardized mean difference (SMD) = 1.07, 95% confidence interval (CI) = 0.58-1.56], FEV1%pred [weighted mean difference (WMD) = 6.67, 95% CI = 5.69-7.64], the FEV1/FVC% (SMD = 1.24, 95% CI = 0.48-2.00), PaO2 (SMD = 1.29, 95% CI = 0.74-1.84), PaCO2 (SMD = -1.88, 95% CI = -2.71 to -1.04), mMRC (WMD = -0.55, 95% CI = -0.65 to -0.45), 6MWD (SMD = 1.63, 95% CI = 0.85-2.42), and CAT (WMD = -1.75, 95% CI = -3.16 to -0.35), respectively. Planned subgroup analysis suggested that EDP-CRTs had a better effect on FEV1, FEV1/FVC%, 6MWD, and CAT in the duration of 2-4 weeks.

Conclusion: EDP-CRTs have better effects on pulmonary function, PaCO2, dyspnea, exercise capacity, and quality of life in COPD patients than CRTs, and the duration to achieve the most effective treatment is 2-4 weeks.

Trial registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022355964).

膈肌外起搏与传统康复疗法相结合对慢性阻塞性肺病患者的影响:系统综述与荟萃分析。
背景:许多随机对照试验(RCT)都报道了膈肌外起搏结合传统康复疗法(EDP-CRTs)对慢性阻塞性肺病(COPD)患者肺功能和运动能力的益处。然而,有关其效果的证据仍不明确:本系统综述和荟萃分析旨在评估 EDP-CRT 与 CRT 对慢性阻塞性肺病患者的影响:设计:系统综述和荟萃分析:我们进行了系统综述和荟萃分析,检索了从开始到2023年9月10日的PubMed、Embase、Cochrane对照试验中央注册、Scopus、中国生物医学文献数据库、中国国家知识基础设施、万方数据库和中国科学期刊论文数据库。研究 EDP-CRT 与 CRT 对慢性阻塞性肺疾病患者影响的 RCT 均被纳入。主要研究结果为肺功能,包括 1 秒用力呼气容积(FEV1)、FEV1 预测值百分比(FEV1%pred)和 FEV1/用力肺活量(FVC)%。次要结果包括动脉血气分析[动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)]、呼吸困难[改良医学研究委员会呼吸困难量表(mMRC)]、运动能力[6分钟步行距离(6MWD)]和生活质量[慢性阻塞性肺病评估测试(CAT)]。荟萃分析采用 RevMan 5.3 软件。纳入研究的质量采用修订版科克伦随机试验偏倚风险工具(RoB 2.0)进行评估。证据的确定性采用建议分级评估、发展和评价系统进行评估:共纳入 13 项研究/981 名参与者。汇总结果显示,EDP-CRT 与 CRT 相比,在 FEV1 [标准化平均差 (SMD) = 1.07,95% 置信区间 (CI) = 0.58-1.56]、FEV1%pred[加权平均差 (WMD) = 6.67,95% CI = 5.69-7.64]、FEV1/FVC%(SMD = 1.24, 95% CI = 0.48-2.00), PaO2 (SMD = 1.29, 95% CI = 0.74-1.84), PaCO2 (SMD = -1.88, 95% CI = -2.71 to -1.04), mMRC (WMD = -0.55, 95% CI = -0.65 to -0.45), 6MWD (SMD = 1.63, 95% CI = 0.85-2.42), 和 CAT (WMD = -1.75, 95% CI = -3.16 to -0.35)。计划中的亚组分析表明,EDP-CRT在2-4周的时间内对FEV1、FEV1/FVC%、6MWD和CAT有更好的效果:结论:与 CRT 相比,EDP-CRT 对 COPD 患者的肺功能、PaCO2、呼吸困难、运动能力和生活质量有更好的效果,达到最有效治疗的时间为 2-4 周:本系统综述和荟萃分析方案已在 PROSPERO 进行了前瞻性注册(编号:CRD42022355964)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
0.00%
发文量
57
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Respiratory Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of respiratory disease.
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