Abstract / Summary
Abstract Pulmonary rehabilitation (PR) is an effective intervention for chronic respiratory diseases (CRD), but its feasibility in low-resource and humanitarian settings remains underexplored. We evaluated a culturally adapted PR programme delivered across refugee camp health facilities, primary-care Upazila Health Complexes, and a District General Hospital in Cox’s Bazar, Bangladesh. We conducted a single-arm mixed-methods feasibility study with assessments at baseline, eight weeks, and six months among adults with CRD participating in an 8-week PR programme comprising supervised exercise, self-management education, and psychosocial support. The primary outcome was exercise capacity measured using the Endurance Shuttle Walk Test (ESWT). Secondary outcomes included health status (COPD Assessment Test [CAT]), breathlessness (modified Medical Research Council [mMRC] Dyspnoea Scale), and psychological wellbeing (Hospital Anxiety and Depression Scale [HADS-A and HADS-D]). Of 91 individuals screened, 50 were enrolled (80% COPD; 20% asthma), yielding a recruitment rate of 54.9%. Adherence to supervised sessions was 100%, and follow-up completion was 98%. Participants had a mean age of 61.7 years (SD 10.1), and 50% were women. Significant improvements were observed across all outcomes (all p < 0.001). Mean ESWT endurance time increased from 181.5 s at baseline to 303.6 s at 8 weeks and 396.2 s at 6 months. Mean CAT scores improved from 23.8 to 11.1, mMRC scores from 2.9 to 1.1, HADS-A scores from 10.2 to 4.9, and HADS-D scores from 11.3 to 4.5 over 6 months. A culturally adapted PR programme was feasible and acceptable in a humanitarian setting and was associated with clinically meaningful improvements in exercise capacity, respiratory symptoms, health status, and psychological wellbeing. To our knowledge, this is the first study to evaluate PR within a refugee camp setting. These findings provide important preliminary evidence to inform the integration of rehabilitation into humanitarian and primary healthcare systems and support further evaluation in controlled effectiveness and implementation studies.