Overviews of respiratory rehabilitation in chronic obstructive pulmonary disease

The purpose of this study was to critically appraise overviews of respiratory rehabilitation in chronic obstructive pulmonary disease (COPD) in order to verify to what extent they convey evidence-based information helpful in implementing new rehabilitation programmes. A Medline search (1985-September 1995) for overviews related to rehabilitation, exercise therapy, education and/or psychological support in COPD was conducted. Chapters of major textbooks of respiratory medicine were also included. The search was limited to the English literature. Two independent reviewers assessed the overviews according to a validated index of scientific quality of research overviews using the following criteria: 1) the literature search method; 2) the inclusion criteria for original articles in the overview; 3) the validity assessment of the original articles; 4) the synthesis of findings; and (5) the conclusion of the overview. Thirty-eight overviews were included. Overall, the methodological quality of the overviews was low (quality score: median 2/7; range 1-5). In only one overview did the author state that the work was based on the results of a literature search. The methodological quality of the primary studies included in the overviews was not included in any of the reviews. The conclusions were only partially supported by the results extracted from the cited primary studies. The widespread application of respiratory rehabilitation in chronic obstructive pulmonary disease should be preceded by demonstrable improvements in function attributable to the intervention. Evidence-based overviews of the literature could assist in implementing new rehabilitation programmes.