Statistical heterogeneity across studies will be assessed using the I2 statistics and the p value of χ2 statistics. The I2 statistics of 25%, 50% and 75% will be categorised as low, moderate and high heterogeneity, respectively.28 A p value of <0.1 will be considered as a statistically significant heterogeneity.23 A subgroup analysis will follow if a meta-analysis of 10 or more studies depicts substantial statistical heterogeneity.23 The between-subgroup heterogeneity will be determined by a fixed-effects model meta-analysis.

We will subgroup by comorbidities, gender, age, CR characteristics and country income groups. A previously published meta-analysis showed that the referral to CR programmes was higher in men (45%) compared with women (38.5%)29; therefore, to understand how the effect estimates might vary between males and females, a gender-wise categorisation will be done. Research further suggests that poor CR programme participation can be influenced by rurality and poverty; therefore, using the World Bank income groups, we will subgroup the studies as low-income, lower-middle-income, upper-middle-income and high-income nations.30 Next, a home-based CR programme is expected to improve participation and outcome, especially in patients who live distant from the specialised CR services.3 A Cochrane review found that home-based CR services might help to ensure better adherence, participation and outcomes than CR provided in specialised centres.31 Therefore, we will dichotomise studies according to whether CR was home-based or was provided in specialised centres, and see how the effect size varies accordingly. Also, we will investigate the effect of CR based on the source of information, whether the source was based on information received through over-phone consultations or from social media channels. These services are new areas of interest and telephone-based counselling has been suggested to be beneficial in reducing hospitalisation, improvement in smoking cessation rates, blood pressure control, and depression and anxiety scores.3 32

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