A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda

Int J Chron Obstruct Pulmon Dis. 2017 Dec 11:12:3533-3539. doi: 10.2147/COPD.S146659. eCollection 2017.

Abstract

Setting: The study was conducted at Mulago Hospital, Kampala, Uganda.

Objective: As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD).

Design: In a pre-post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken.

Results: In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR.

Conclusion: PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.

Keywords: exercise training; nonpharmacological intervention; self-management; tuberculosis.

Publication types

  • Video-Audio Media

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chest Pain / etiology
  • Chest Pain / physiopathology
  • Chest Pain / rehabilitation
  • Exercise Test
  • Exercise Therapy / methods*
  • Exercise Tolerance
  • Feasibility Studies
  • Female
  • Health Knowledge, Attitudes, Practice
  • Hemoptysis / etiology
  • Hemoptysis / physiopathology
  • Hemoptysis / rehabilitation
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Quality of Life
  • Recovery of Function
  • Self Care / methods*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Tuberculosis, Pulmonary / complications
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / physiopathology
  • Tuberculosis, Pulmonary / rehabilitation*
  • Uganda / epidemiology
  • Young Adult