A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence

D Langer, Ejm Hendriks, C Burtin, V Probst, Cees van der Schans, Wj Paterson, McE Verhoef-de Wijk, Rvm Straver, M Klaassen, T Troosters, M Decramer, V Ninane, P Delguste, J Muris, R Gosselink

Research output: Contribution to journalArticleAcademicpeer-review


PURPOSE: Update of a clinical practice guideline for the physiotherapy management of patients with chronic obstructive pulmonary disease supporting the clinical decision-making process.

METHODS: A systematic computerized literature search was performed on different modalities for improving physical exercise capacity, reducing exertional dyspnoea, improving airway clearance and encouraging changes in physical activity behaviour. Methodological quality was scored with the PEDro Scale. Scientific conclusions were graded according to the criteria of the; Dutch Evidence Based Guideline Development Platform'. These, together with practical considerations, were used to formulate recommendations for clinical practice.

RESULTS: A total of 103 studies were included in the systematic review, consisting of five meta-analyses of randomized controlled trials, 84 randomized controlled trials and 14 uncontrolled studies. Twenty scientific conclusions supported six recommendations on physical exercise training. Nineteen scientific conclusions supported eight recommendations on interventions for reducing dyspnoea. Five scientific conclusions supported seven recommendations concerning treatment modalities to improve mucus clearance, and two scientific conclusions supported two recommendations on strategies for encouraging permanent changes in physical activity behaviour.

CONCLUSIONS: Strong recommendations support the use of physical exercise training to improve health-related quality of life and functional exercise capacity. Future research should investigate whether additional interventions for reducing exertional dyspnoea have a place as adjuncts to physical exercise training in selected patients. In addition, treatment of impaired mucus clearance, especially during acute exacerbations, requires further research. With the advance of new technologies for objective measurements of physical activities in daily life more research is needed concerning interventions to initiate and maintain physical activity behaviour change during and after supervised physical exercise training programmes.

Original languageEnglish
Pages (from-to)445-462
Number of pages18
JournalClinical Rehabilitation
Issue number5
Publication statusPublished - 23 Apr 2009


  • Dyspnea
  • Electric Stimulation Therapy
  • Exercise
  • Exercise Tolerance
  • Health Behavior
  • Humans
  • Motor Activity
  • Mucus
  • Oxygen Inhalation Therapy
  • Patient Education as Topic
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive
  • Quality of Life
  • Respiration
  • Respiratory Therapy
  • Journal Article
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review


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