Effectiveness of pulmonary rehabilitation on functional exercise capacity & health related quality of life (HRQOL) among individuals with post tuberculosis lung disease: A multicentric pre & post-interventional study

Background & objectives Pulmonary rehabilitation (PR) has been extensively studied and proven beneficial in various respiratory conditions such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Individuals with post-tuberculosis lung disease (P-TBLD) have limited exercise tolerance and a significant disability affecting daily living, much like those with COPD. Hence, they appear to be good candidates for PR. This study aimed to determine the effectiveness of an outpatient PR protocol on functional exercise capacity and health-related quality of life (HRQOL) in individuals with P-TBLD. Furthermore, the effectiveness of adherence to the PR protocol among the participants as well as identifying the gaps and barriers in accessing PR were also determined. Methods This is a multicentric pre- and post-interventional study conducted across five centres in India. 260 individuals with P-TBLD were included if they could complete more than 80 per cent of the physiotherapist's training sessions at the time of enrollment had previously received treatment for pulmonary tuberculosis and were negative for acid fast bacilli (AFB) on sputum examination. Individuals were excluded if they had preexisting lung disease other than P-TBLD or suffered from any mental, neurological, musculoskeletal, or unstable cardiovascular disease that could impair their performance during the exercise training sessions. Pre- and post-intervention assessments included clinical symptoms, exercise intolerance, pulmonary function test (PFT), 6-minute walk test (6MWT), muscle strength testing, and St. George Respiratory Questionnaire (SGRQ) score for HRQOL. Participants received PR training at first visit in OPD and were advised to follow it at home and telephonic follow up was done for a duration of 12 wk. Results Out of the 260 participants who were enrolled, 246 patients completed the post-intervention evaluation following 12 wk of the PR protocol. Clinical parameters, the 6MWT, the functional balance test, and the muscle strength test all showed significant improvement after PR. Significant improvement was observed across all domains of the SGRQ score. Pulmonary function measures showed significant improvement in FEV1 and FVC parameters post intervention. Interpretation & conclusions This study provides compelling evidence that PR is beneficial for post-TB patient, leading to notable improvements in the exercise capacity, symptom management as well as the overall quality of life. The findings support the implementation of PR protocol on a larger scale within national health frameworks, particularly in countries with high TB prevalence. By integrating PR into the National Tuberculosis Elimination Programme, it is possible to offer a comprehensive care approach that sets standard indicators for the surveillance of P-TBLD and addresses the long-term health needs of TB survivors.