Clinical and cost-effectiveness of pulmonary rehabilitation for people with post-tuberculosis lung disease in Kyrgyzstan: A Single-blind Randomized Controlled Trial

Rationale Tuberculosis (TB) is a major worldwide cause of disability, with TB survivors experiencing significant and often under-recognised burden, and approximately half going on to develop post-tuberculosis lung disease (PTLD). Pulmonary rehabilitation may offer effective disease management but there is a lack of evidence in PTLD populations. Objectives We aimed to determine the clinical and cost effectiveness of pulmonary rehabilitation for adults living with PTLD in Kyrgyzstan. Methods A single-blind randomised controlled trial, conducted March 2021 to June 2022 in Bishkek, Kyrgyzstan, compared supervised PR to usual care for adults living with PTLD. Participants were randomised (1:1) to receive either usual care (control) or culturally adapted pulmonary rehabilitation (intervention), comprising individually prescribed and tailored exercise and self-management education. The primary outcome was change in maximal exercise capacity, measured by the incremental shuttle walking test (ISWT), from baseline to the end of 6-weeks of pulmonary rehabilitation, analysed by intention-to-treat analysis. Secondary outcomes included health-related quality of life (HRQoL) and cost-effectiveness analysis. Results 114 participants (mean ± SD 43.3 ± 15.2 years, 57% male) received either supervised pulmonary rehabilitation or usual care. Compared with the control group, changes in exercise capacity and HRQoL from baseline were significantly greater in the intervention group (ISWT: 123.0 m, 95%CI 81.2-164.8, P Conclusions In adults with PTLD in Kyrgyzstan, a culturally adapted pulmonary rehabilitation programme significantly improved exercise capacity and HRQoL compared with usual care and was both clinically and cost effective.