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Background <p>Pulmonary rehabilitation (PR) is an effective intervention for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) following hospitalization. However, the optimal timing for initiating PR after admission remains controversial. This study conducted a systematic review and network meta-analysis to evaluate the therapeutic effects of initiating PR at different time points, with the aim of providing evidence-based recommendations to inform clinical decision-making and guideline development.</p> Methods <p>Randomized controlled trials (RCTs) on PR following AECOPD were systematically searched in the PubMed, Embase, Web of Science, and Cochrane Library databases. The primary outcome was hospital readmissions. Prespecified secondary outcomes were: exercise capacity (six-minute walk test, 6MWT), lung function (forced expiratory volume in one second, percent predicted, FEV₁%), health-related quality of life (St. George’s Respiratory Questionnaire, SGRQ), Dyspnoea (modified Medical Research Council scale, mMRC; modified Borg scale, mBorg), mortality, and adverse events. Data analysis was conducted using R software and Stata. Study quality and risk of bias were assessed using the TESTEX tool and the Cochrane ROB 2 tool. This study was prospectively registered in the PROSPERO database (CRD42024550770).</p> Results <p>A total of 26 studies involving 1,800 patients evaluated four PR initiation time points. Network meta-analysis showed that PR initiated within 2&#xa0;weeks after discharge was statistically effective in reducing hospital readmissions, alleviating mMRC, and improving SGRQ compared with usual care, and it ranked highest for these outcomes. In contrast, initiating PR after 48&#xa0;h of hospital admission was statistically effective in improving 6MWT and ranked highest for this outcome. No statistically significant differences were observed across initiation timings for mortality, predicted FEV₁%, or dyspnoea mBorg scale.</p> Conclusions <p>Initiating PR within two weeks post-discharge is most effective for reducing readmissions, alleviating dyspnoea, and enhancing quality of life, whereas initiating after 48&#xa0;h of admission provides greater benefits for improving exercise capacity. These findings support a pragmatic rehabilitation pathway combining early in-hospital and structured post-discharge PR. Further high-quality RCTs are needed to confirm optimal timing strategies.</p>

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The timing of the commencement of pulmonary rehabilitation in hospitalized patients with acute exacerbation of COPD: a systematic review and network meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月16日

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  • Peilin Jia,
  • Hailong Zhang,
  • Ya Li,
  • Zhaoxu Yao,
  • Longyu Wang

摘要

Background

Pulmonary rehabilitation (PR) is an effective intervention for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) following hospitalization. However, the optimal timing for initiating PR after admission remains controversial. This study conducted a systematic review and network meta-analysis to evaluate the therapeutic effects of initiating PR at different time points, with the aim of providing evidence-based recommendations to inform clinical decision-making and guideline development.

Methods

Randomized controlled trials (RCTs) on PR following AECOPD were systematically searched in the PubMed, Embase, Web of Science, and Cochrane Library databases. The primary outcome was hospital readmissions. Prespecified secondary outcomes were: exercise capacity (six-minute walk test, 6MWT), lung function (forced expiratory volume in one second, percent predicted, FEV₁%), health-related quality of life (St. George’s Respiratory Questionnaire, SGRQ), Dyspnoea (modified Medical Research Council scale, mMRC; modified Borg scale, mBorg), mortality, and adverse events. Data analysis was conducted using R software and Stata. Study quality and risk of bias were assessed using the TESTEX tool and the Cochrane ROB 2 tool. This study was prospectively registered in the PROSPERO database (CRD42024550770).

Results

A total of 26 studies involving 1,800 patients evaluated four PR initiation time points. Network meta-analysis showed that PR initiated within 2 weeks after discharge was statistically effective in reducing hospital readmissions, alleviating mMRC, and improving SGRQ compared with usual care, and it ranked highest for these outcomes. In contrast, initiating PR after 48 h of hospital admission was statistically effective in improving 6MWT and ranked highest for this outcome. No statistically significant differences were observed across initiation timings for mortality, predicted FEV₁%, or dyspnoea mBorg scale.

Conclusions

Initiating PR within two weeks post-discharge is most effective for reducing readmissions, alleviating dyspnoea, and enhancing quality of life, whereas initiating after 48 h of admission provides greater benefits for improving exercise capacity. These findings support a pragmatic rehabilitation pathway combining early in-hospital and structured post-discharge PR. Further high-quality RCTs are needed to confirm optimal timing strategies.