Methods of studying the effectiveness of physical therapy and pulmonary rehabilitation of COPD patients (systematic review)

K. Tymruk-Skoropad


Introduction. Most of the modern protocols for pulmonary rehabilitation and management of COPD patients provide recommendations for diagnostic methods of research and substantiation of indicators laying the basis for the treatment strategy. Recommendations on research methods and indicators which should be used as criteria of the physiotherapeutic intervention effectiveness are insufficient. Purpose of the study. To analyze research methods that are most commonly used to evaluate the effectiveness of physical therapy and pulmonary rehabilitation of COPD patients. Materials and methods of research. 10 systematic reviews of the Cochrane web library on physical therapy and pulmonary rehabilitation (based on the analysis of 145 randomized trials) have been analyzed. The methods of research and the indicators laying the basis for the evaluation of the physical therapy/pulmonary rehabilitation results have been determined. Results. 550 research methods/indicators have been analyzed. Conclusions. Most survey methods used in randomized trials related to pulmonary rehabilitation (and/or physical therapy) in the case of COPD can be divided into assessment groups 1) quality of life and its components, manifestation of the disease symptoms; 2) level of physical efficiency and endurance, motor sphere; 3) state of the cardiorespiratory system; 4) integral indicators; 5) indicators of hospitalization, exacerbations, and mortality; 6) indicators of awareness, literacy, and education of patients. None of the research methods can reflect the diversity of pathogenetic manifestations of COPD, adequately describe the nature/severity of the disease, or provide information on the physical therapy effectiveness. In order to conduct a comprehensive evaluation of the rehabilitation of COPD patients it is advisable to use at least one of the study methods from each distinguished group.


physical therapy; chronic obstructive pulmonary disease; pulmonary rehabilitation; COPD; methods of research; quality of life


de Alvarenga, G., Remigio Gamba, H., Elisa Hellman, L., Ganzert Ferrari, V., & Michel de Macedo, R. (2016). Physiotherapy Intervention During Level I of Pulmonary Rehabilitation on Chronic Obstructive Pulmonary Disease: A Systematic Review. The Open Respiratory Medicine Journal, 10(1), 12-19. doi: 10.2174/1874306401610010012.

Nowobilski, R., Włoch, T., Płaszewski, M., & Szczeklik, A. (2010). Efficacy of physical therapy methods in airway clearance in patients with chronic obstructive pulmonary disease: a critical review. Polskie Archiwum Medycyny Wewnętrznej, 120(11), 468–477. Retrieved from

Tymruk-Skoropad, K., Tsizh, L., Vynogradskyi, B., & Pavlova, I. (2018). Physical therapy in chronic obstructive pulmonary disease (analysis of the evidence-based medicine). Physiotherapy Quarterly, 26(2), 1–8. 10.1515/physio-2017-0001.

Krakhmalova, O.O., Voyeykova, L.S., & Talalay, I.V. (2011). Systemic inflammation as a factor in the development of extrapulmonary complications of copd. Ukrainian teraupetic journal, 2, 79-83. (in Ukrainian).

Tymruk-Skoropad K. (2017). Dysfunction of peripheral muscle through the chronic obstructive pulmonary disease. Young sport science of Ukraine, Т.3, с. 100-101. (in Ukrainian).

Chatila, W. M., Thomashow, B. M., Minai, O. A., Criner, G. J., & Make, B. J. (2008). Comorbidities in Chronic Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society, 5(4), 549–555.

Divo, M. J., Casanova, C., Marin, J. M., Pinto-Plata, V. M., De-Torres, J. P., Zulueta, J. J., & Celli, B. R. (2015). COPD comorbidities network. European Respiratory Journal, 46(3), 640–650.

Raherison, C., Ouaalaya, E., Bernady, A., Casteigt, J., Nocent-Eijnani, C., Falque, L., & Molimard, M. (2018). Comorbidities and COPD severity in a clinic-based cohort. BMC Pulmonary Medicine, 18(117), 1–10.

Tymruk-Skoropad K.A. (2017). Approaches to using of international classification of functioning (ICF) in practice of physical therapy of persons with chronic obstructive pulmonary disease, Sport science of Ukraine, 5(81), 46-53. (in Ukrainian).

Gendron, M. L., Nyberg, A., Maltais, F., & Lacasse, Y. (2016). Active mind-body movement therapies as an adjunct to or in comparison to pulmonary rehabilitation for people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (7).

Lenferink, A., Brusse-Keizer, M., van der Valk, P. D., Frith, P. A., Zwerink, M., Monninkhof, E. M., & Effing, T. W. (2017). Self management interventions including action plans for exacerbations versus usual care in people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (8), 1–178.

McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015(2), 1–209.

McKeough, Z., Velloso, M., Lima, V., & Alison, J. (2016). Upper limb exercise training for COPD. TT -. The Cochrane Database of Systematic Reviews, 11(11), CD011434.

Mcnamara, R., Mckeough, Z., Mckenzie, D., & Alison, J. (2013). Water-based exercise training for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (12).

Menadue, C., Piper Amanda, J., Van’t Hul Alex, J., & Wong Keith, K. (2009). Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (2).

Nonoyama, M., Brooks, D., Lacasse, Y., Gh, G., & Goldstein, R. (2007). Oxygen therapy during exercise training in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (3).

Puhan, M. A., Gimeno- Santos, E., Cates, C. J., & Troosters, T. (2016). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (12).

Rutten-Van Mölken, M., Roos, B., & Van Noord, J. A. (1999). An empirical comparison of the St George’s Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ) in a clinical trial setting. Thorax, 54(March 2008), 995–1003.

Chronic Obstructive Pulmonary Disease: Use of the St. George’s Respiratory Questionnaire as a PRO Assessment Tool Guidance for Industry. (2018). Retrieved from

Tabberer, M., & Paul, W. J. (2017). The COPD Biomarkers Qualification Consortium Database : Baseline Characteristics of the St George ’ s Respiratory Questionnaire Dataset. Journal of the COPD Foundation Chronic Obstructive Pulmonary Diseases, 4(2), 112–123. Retrieved from

Guyatt, G. H., Berman, L. B., Townsend, M., Pugsley, S. O., & Chambers, L. W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax, 42(10), 773–778.

Chauvin, A., Rupley, L., Meyers, K., Johnson, K., & Eason, J. (2008). Outcomes in Cardiopulmonary Physical Therapy: Chronic Respiratory Disease Questionnaire (CRQ). Cardiopulmonary Physical Therapy Journal, 19(2), 61–67. Retrieved from

Buss, A. S., & Silva, L. M. C. da. (2009). Estudo comparativo entre dois questionários de qualidade de vida em pacientes com DPOC. Jornal Brasileiro de Pneumologia, 35(4), 318–324.

Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., & Singh, S. J. (2014). An official European respiratory society/American thoracic society technical standard: Field walking tests in chronic respiratory disease. European Respiratory Journal, 44(6), 1428–1446.

Smid, D. E., Franssen, F. M., Houben-Wilke, S., Vanfleteren, L. E., Janssen, D. J., Wouters, E. F., & Spruit, M. A. (2017). Responsiveness and MCID Estimates for CAT, CCQ, and HADS in Patients With COPD Undergoing Pulmonary Rehabilitation: A Prospective Analysis. Journal of the American Medical Directors Association, 18(1), 53–58.

Nowak, C., Sievi, N. A., Clarenbach, C. F., Schwarz, E. I., Schlatzer, C., Brack, T., & Kohler, M. (2014). Accuracy of the hospital anxiety and depression scale for identifying depression in chronic obstructive pulmonary disease patients. Pulmonary Medicine, 2014.

Crisafulli, E., & Clini, E. M. (2010). Measures of dyspnea in pulmonary rehabilitation. Multidisciplinary Respiratory Medicine, 5(3), 202–210.

Alvar, A., Decramer, M., & Frith, P. (2010). Global Initiative for Chronic Obstructive Lung A Guide for Health Care Professionals Global Initiative for Chronic Obstructive Disease. Global Initiative for Chronic Obstructive Lung Disease, 22(4), 1–30.

Grosbois, J. M., Riquier, C., Chehere, B., Coquart, J., Béhal, H., Bart, F., & Chenivesse, C. (2016). Six-minute stepper test: A valid clinical exercise tolerance test for COPD patients. International Journal of COPD, 11(1), 657–663.

Crapo, R. O., Casaburi, R., Coates, A. L., Enright, P. L., MacIntyre, N. R., McKay, R. T., & Mottram, C. (2002). ATS statement: Guidelines for the six-minute walk test. American Thoracic Society, 166(1), 111–117.

Chen, H., Liang, B.-M., Tang, Y.-J., Xu, Z.-B., Wang, K., Yi, Q., & Feng, Y.-L. (2012). Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities. Chinese Medical Journal, 125(17), 3053–3058. Retrieved from

Singh, S. J., Puhan, M. A., Andrianopoulos, V., Hernandes, N. A., Mitchell, K. E., Hill, C. J., & Holland, A. E. (2014). An official systematic review of the European Respiratory Society/American Thoracic Society: Measurement properties of field walking tests in chronic respiratory disease. European Respiratory Journal, 44(6), 1447–1478.

Hernandes, N. A., Wouters, E. F. M., Meijer, K., Annegarn, J., Pitta, F., & Spruit, M. A. (2011). Reproducibility of 6-minute walking test in patients with COPD. European Respiratory Journal, 38(2), 261–267.

Singh, S., Morgan, M., Scott, S., Walters, D., & Hardman, A. (1992). Development of a shuttle walking test of disability in patients with chronic airflow obstruction. Thorax, 47, 1019–1024.

Leung, R. W. M., Alison, J. A., McKeough, Z. J., & Peters, M. J. (2010). Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): A randomised trial. Journal of Physiotherapy, 56(2), 105–112.

Pepin, V., Brodeur, J., Lacasse, Y., Milot, J., LeBlanc, P., Whittom, F., & Maltais, F. (2007). Six-minute walking versus shuttle walking: Responsiveness to bronchodilation in chronic obstructive pulmonary disease. Thorax, 62(4), 291–298.

Revill, S. M., Noor, M. Z., Butcher, G., & Ward, M. J. (2010). The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen. Chronic Respiratory Disease, 7(4), 239–245.

Kaymaz, D., Candemir, İ. Ç., Ergün, P., Demir, N., Taşdemir, F., & Demir, P. (2018). Relation between upper-limb muscle strength with exercise capacity, quality of life and dyspnea in patients with severe chronic obstructive pulmonary disease. The Clinical Respiratory Journal, 12(3), 1257–1263.

Jones, P. W. (2006). Outcomes and markers in the assessment of chronic obstructive pulmonary disease. European Respiratory Journal, 27(4), 822–832.

Avdeev, S. N. (2006). Pulmonary hyperinflation in patients with COPD - Consilium Medicum №03 2006 - Consilium Medicum. Retrieved August 4, 2018, from

Amalakanti, S., & Pentakota, M. R. (2016). Pulse Oximetry Overestimates Oxygen Saturation in COPD. Respiratory Care, 61(4), 423–427.

Iashyna L. A., & Opimakh, S. G. (2014). Lung function and gas exchange assessment possibilities in chronic obstructive pulmonary disease patients in clinical practice. Asthma and allergy, 4, 8–12.

Nitzan, M., Romem, A., & Koppel, R. (2014). Pulse oximetry: Fundamentals and technology update. Medical Devices: Evidence and Research, 7(1), 231–239.

Perkins, G. D., McAuley, D. F., Giles, S., Routledge, H., & Gao, F. (2003). Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation? Critical Care, 7(4), R67-R71.

Jubran, A., & Tobin, M. J. (1990). Reliability of pulse oximetry in titrating supplemental oxygen therapy in ventilator-dependent patients. Chest, 97(6), 1420–1425.

Seguin, P., Le Rouzo, A., Tanguy, M., Guillou, Y. M., Feuillu, A., & Mallédant, Y. (2000). Evidence for the need of bedside accuracy of pulse oximetry in an intensive care unit. Critical Care Medicine, 28(3), 703–706. Retrieved from

Seguin, P., Le Rouzo, A., Tanguy, M., Guillou, Y. M., Feuillu, A., & Mallédant, Y. (2000). Evidence for the need of bedside accuracy of pulse oximetry in an intensive care unit. Critical Care Medicine.

Ries, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C. F., Mahler, D. A., & Herrerias, C. (2007). Pulmonary Rehabilitation. Chest, 131(5), 4S–42S.

White, R., Walker, P., Roberts, S., Kalisky, S., & White, P. (2006). Bristol COPD knowledge questionnaire (BCKQ): Testing what we teach patients about COPD. Chronic Respiratory Disease, 3(3), 123–131.



  • There are currently no refbacks.

Copyright (c) 2018 Health, sport, rehabilitation