Community-Based Pulmonary Rehabilitation for Active and Post-Tuberculosis Lung Disease in LICs/LMICs: A Scoping Review

Tuberculosis (TB) remains one of the leading infectious causes of death globally, and survivors frequently carry a lasting burden well beyond microbiological cure: post-TB lung disease (PTLD), characterized by persistent respiratory impairment, reduced functional capacity, and diminished quality of life. Pulmonary rehabilitation (PR) — a multimodal intervention combining progressive exercise training, respiratory technique training, and self-management education — is well established as reducing this burden in high-income settings. However, its translation to low-income and lower-middle-income countries (LICs/LMICs), where the global TB burden is concentrated and specialist rehabilitation infrastructure is scarce, has been far more limited. To date, there is a dearth of evidence synthesizing how PR is actually delivered at community level in these settings — what components constitute it, what delivery models make it feasible outside tertiary rehabilitation centers, and what implementation strategies have supported its uptake. This scoping review addresses that gap. The review is guided by two research questions: first, what components and delivery models constitute community-based PR for active TB and post-TB lung disease in LICs/LMICs; second, what implementation strategies have been used to deliver these interventions at community level. These questions are addressed through three deliberately separated analytical layers. The first charts the clinical content of PR programmes — progressive exercise, respiratory technique training, education, and psychosocial support — as distinct from how programmes are delivered. The second maps delivery-support activities onto the 73-strategy Expert Recommendations for Implementing Change (ERIC) compilation (Powell et al., 2015), distinguishing strategies authors framed as deliberate implementation choices from those reported only as clinical or logistical practice. The third specifies the most frequently evidenced strategies using Proctor, Powell and McMillen's (2013) Name it/Define it/Specify it framework, characterizing each by actor, action, target, temporality, dose, and the implementation outcome it is understood to affect. This three-layer structure is a deliberate methodological choice: PR components, delivery forms, and implementation strategies are conceptually distinct constructs and are not permitted to collapse into one another during charting. Methodologically, the review follows Arksey and O'Malley's (2005) five-stage scoping review framework as advanced by Levac et al. (2010), and is reported according to PRISMA-ScR (Tricco et al., 2018). A systematic search across six databases (CINAHL, Cochrane Library, Embase, MEDLINE/PubMed, Scopus, and Web of Science) from 2000 onward yielded a corpus of 15 included studies spanning randomized trials, pre-post designs, qualitative research, case reports, and two prior reviews, concentrated largely in India with additional evidence from Bangladesh and Malawi. The unit of analysis is the PR programme itself rather than the patient cohort it served — a decision that allows studies in which TB or post-TB patients form only part of a broader chronic respiratory disease cohort to be retained, provided the proportion of TB/post-TB patients is charted transparently rather than presented as evidence of clinical effectiveness in TB populations specifically. The review does not evaluate clinical effectiveness, and no formal risk-of-bias appraisal or meta-analysis is undertaken, consistent with scoping review methodology and its descriptive rather than evaluative aim. Its expected contribution is a structured account of what community-based PR for TB and post-TB lung disease currently looks like in resource-limited settings: which clinical components are combined into these programmes, which delivery forms — task-shifted, home-based, facility-to-home, and telerehabilitation-supported models — make them feasible outside specialist centers, and which implementation strategies, however implicitly reported, have supported their delivery. By making this evidence base explicit, and by harmonizing the fragmented ERIC terminology used across a small and heterogeneous corpus, the review is intended to inform the design of future community-based PR programmes and to identify where methodological gaps — the near-absence of documented fidelity measurement, cost data, or comparative evaluation of task-shifting configurations — most urgently need addressing in implementation research on TB-endemic, resource-constrained settings.