Engstrom 1999.

Study characteristics
Methods	RCT; follow‐up: 12 months; control group: usual outpatient care
Participants	Eligible: 58 Randomised: 55 Completed: 50, I: 26, C: 24 Mean age: I: 66 years, C: 67 years Sex (% male): I: 54, C: 50 Inclusion criteria: clinical diagnosis of COPD, developing after ≥ 10 years of smoking, FEV₁ < 50%, debut of symptoms after 40 years of age, dyspnoea mainly elicited by exercise or infection, no allergy Major exclusions: disabling or severe disease, coexistence of other causes of impaired pulmonary function
Interventions	12‐month rehabilitation programme including ‐ Exercise training sessions (bicycle, arm, and breathing techniques), 2/week for 6 weeks, once weekly for 6 weeks, once every second week for 6 weeks, and then once a month for remaining period. Every session: 45 minutes. Furthermore, instructions for daily walks and an individualised daily 30‐minute home training programme ‐ Individualised educational programme with outpatient team (nurse and physician) on visit every 3 months ‐ Occupational therapist gave 2 group sessions about energy‐saving techniques and 2 global educational sessions ‐ Dietician gave information about nutrition for COPD patients and intervened in malnutrition Intervention duration: 12 months Involved disciplines: physiotherapist, nurse, physician, dietician, occupational therapist
Outcomes	SGRQ, 6MWD, W‐max, days in hospital, SIP, MACL
Notes	Dominant c omponent: exercise
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: no information reported
Allocation concealment (selection bias)	High risk	Quote: "patients with COPD were recruited consecutively and, when a sufficient number had been collected, randomised to produce a rehab group and a control group of equal size"
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: participants and treating therapists not likely to have been blinded to group allocation
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "all the physiological and QOL assessments were blinded, except the walking test, which was performed by the nurse in the rehabilitation team"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: missing outcome data balanced in numbers across intervention and control groups (2 vs 3 persons)
Selective reporting (reporting bias)	Low risk	Comment: study protocol is not available, but it is clear that published reports include all expected outcomes, including those that were pre‐specified