To determine what the impact of a contextually relevant pulmonary rehabilitation programme would have on persons living with TB, with or without HIV co-infection, on outcomes related to lung function, functional capacity and quality of life.
A pilot randomised, single blinded, pre-test-post-test design was used. Inclusion criteria were all adult males and females between 18-65 years with TB confirmed by Gene Xpert, irrespective of number of TB episodes, HIV status or having chronic obstructive pulmonary disease. Participants had to be within their first week of TB treatment. Fifty eight participants were randomized into a control group (CG) receiving only pharmacological therapy and the intervention group (IG) who received pulmonary rehabilitation in addition to pharmacological therapy . The pulmonary rehabilitation programme was 12 weeks long and consisted of two weekly sessions of 45minutes each, which was delivered at a community centre. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a Three -minute step test and spirometry at three time points namely at enrolment, at six weeks and at 12 weeks respectively.
There were 29 participants in each group. Nearly half of participants were persons with diagnosis of TB for the first time, with the participants in the IG having overall reported more recurring TB incidences (n=16 vs n=13).
At baseline 48% of participants in the CG had abnormal lung function compared to 67% in the IG. At 6 weeks there was no change in the CG regarding lung abnormalities. However, the IG now only had 33% of abnormal lung function at the same time point. Although there was no statistical significance for any of the lung function categories, there was a 42% improvement in normal lung function at 6 weeks in the IG compared to the CG at baseline. The median baseline number of steps taken by the CG was 79 steps (IQR:42-134) vs 117 steps by the IG (IQR:84-154). T-test conducted to test the difference between means for the CG and IG was statistically significant for the step test (p=0.002) at 6 weeks for the IG, but not at 12weeks (p=0.13). No correlation was found between the SGRQ (QoL parameter) and any lung function parameter (p>0.05) at 12 weeks.
Although the changes in lung function, functional capacity and quality of life did not reach statistical significance at completion of the PRP for the IG, the continued improvement in all these outcomes for the IG from 0 weeks to 12 weeks holds potential clinical significance.
This is one of the first studies providing pulmonary rehabilitation to people with TB in South Africa. Physiotherapists are well equipped to provide this adjunctive therapy which has the potential to maintain good lung health and reduce future health costs.
community based
education
