Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

Background: Pulmonary rehabilitation is a highly effective non-pharmacological treatment for patients with chronic respiratory diseases.

Objectives: We aimed to synthesize the evidence for practice and efficacy of pulmonary rehabilitation in sub-Saharan Africa.

Methods: We searched in PubMed and Scopus for relevant studies as well as scanned reference lists of relevant studies from these databases for additional studies. Articles meeting the inclusion criteria were included. Pre-determined data were extracted independently by two reviewers. A narrative synthesis approach was used in the interpretation of findings.

Results: Six studies were included, totalling 275 participants. Indications for pulmonary rehabilitation were chronic obstructive pulmonary disease, asthma, pulmonary tuberculosis and post-tuberculosis lung disease. Programmes ran for 6-12 weeks, universally incorporated exercise, and variously used home-based and hospital-based delivery models. All were interventional studies, of which two were randomized controlled trials, and primarily reported pulmonary function and exercise tolerance endpoints. Evidence for individualising the exercise regimen was available in three studies.

Conclusions: There is limited evidence on the design and efficacy of pulmonary rehabilitation in sub-Saharan Africa, but available data support its use in a variety of chronic respiratory conditions. Future studies should report core outcome sets and their individualised exercise and education regimens.

PROSPERO registration number: CRD42019128929