Effect of pulmonary rehabilitation on lung function and quality of life in pulmonary tuberculosis survivors with post-tuberculosis lung disease: a systematic review and meta-analysis

Abstract Background Post-tuberculosis lung disease (PTLD) is a significant global public health challenge. The contribution PTLD on long-term morbidity and impaired quality of life is increasingly recognized. There is limited evidence on effective management strategies of PTLD. This systematic review and meta-analysis aimed to evaluate the effect of pulmonary rehabilitation (PR) in improving lung function and health related quality of life (HRQoL) among individuals with post-tuberculosis lung disease. Methods This systematic review and meta-analysis was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies involving pulmonary tuberculosis (TB) survivors who had completed treatment and developed post-TB lung disease (PTLD), as defined by the individual studies, were included. A comprehensive literature search was conducted on PubMed, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Google scholar between July 25 and August 1, 2025. Data were extracted by two individuals using a structured, pre-designed Excel form. The extracted data were cleaned and analyzed using R software version 4.5. A random effect model was employed to accommodate methodological variation. Results A total of 13 studies, including one randomized controlled trial, one prospective cohort study, and 11 pre-post interventional studies, consisting of 747 participants were included. With very low certainty evidence, the pooled mean change of 6-minute walk distance (6MWD) was 60.04 m (95% CI: 27.83−92.20). Low certainty evidence showed the pooled mean change in forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), the ratio of forced expiratory volume to forced vital capacity (FEV1/FVC) and partial pressure of oxygen in arterial blood (pao2) were 0.07 L (95% CI: 0.01;0.14), 0.06 L (95% CI: -0.02;0.14), 1.06% (95% CI: -1.66;3.78) and 2.64 mmHg (95% CI: 0.15;5.12) respectively. The mean change in SGRQ scores was −18.85 (95% CI: −22.43−15.27) based on low certainty evidence. Conclusion Despite methodological heterogeneity and lack of randomized controlled study, pulmonary rehabilitation is a promising intervention in improving exercise tolerance, lung function and HRQoL of PTLD patients, though the certainty of evidence ranges from low to very low. More high-quality Randomized Clinical Trial (RCT) and longitudinal studies are needed to have strong evidence to recommend PR programs as part of regular recommendation for PTLD care to achieve better health outcomes.