Ann Rehabil Med.  2019 Oct;43(5):592-614. 10.5535/arm.2019.43.5.592.

Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

• Kruapanich C
• Tantisuwat A
• Thaveeratitham P
• Lertmaharit S
• Ubolnuar N
• Mathiyakom W

• KMID: 2463707
• DOI: http://doi.org/10.5535/arm.2019.43.5.592

Abstract

OBJECTIVE
To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity.
METHODS
Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval.
RESULTS
Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control.
CONCLUSION
Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).

Keyword

Chronic obstructive pulmonary disease; Dyspnea; Meta-analysis; Quality of life; Upper limb training

MeSH Terms

Bias (Epidemiology)
Dyspnea
Humans
Pulmonary Disease, Chronic Obstructive*
Quality of Life
Rehabilitation
Resistance Training
Sample Size
Upper Extremity*

Figure

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  Fig. 1. Search strategy and flow diagram of article screening process.

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  Fig. 2. The risk of bias assessment of included studies by the Cochrane Collaboration’s tool.

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  Fig. 3. Forest plot showing difference in dyspnea by comparing modes of upper limb (UL) training with control condition (A) and by patient severity (B).

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  Fig. 4. Forest plot showing difference in quality of life from Chronic Respiratory Disease Questionnaire (CRQ) score by comparing modes of upper limb (UL) training with control condition (A) and by patient severity (B).

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  Fig. 5. Forest plot showing difference in quality of life from St. George’s Respiratory Questionnaire (SGRQ) by comparing modes of upper limb (UL) training with control condition (A) and by patient severity (B).

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  Fig. 6. Forest plot showing difference in upper limb (UL) fatigue by comparing modes of UL training with control condition.

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  Fig. 7. Forest plot showing difference in upper limb (UL) function by comparing modes of UL training with control condition.

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  Fig. 8. Forest plot showing difference in upper limb (UL) exercise tolerance by comparing modes of UL training with control condition.

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