State of the art: How to set up a pulmonary rehabilitation program

Authors

  • Sue JENKINS,

    Corresponding author
    1. Physiotherapy Department, Sir Charles Gairdner Hospital
    2. School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University
    3. Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Western Australia, Australia
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  • Kylie HILL,

    1. School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University
    2. Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Western Australia, Australia
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  • Nola M. CECINS

    1. Physiotherapy Department, Sir Charles Gairdner Hospital
    2. School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University
    3. Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Western Australia, Australia
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  • The Authors: Dr Sue Jenkins, PhD, is Associate Professor of Cardiopulmonary Science at Curtin University (School of Physiotherapy) and Sir Charles Gairdner Hospital (SCGH, Physiotherapy Department), and head of the Physiotherapy Unit at the Lung Institute of Western Australia (Perth, Western Australia). Dr Jenkins is an author of the Australian and New Zealand Guidelines for the Management of COPD (The COPD-X Plan) and The Pulmonary Rehabilitation Toolkit. Her research interests include exercise testing and training in patients with chronic lung disease. Dr Jenkins has presented pulmonary rehabilitation workshops in many countries within Asia as well as throughout Australia and in New Zealand. Dr Kylie Hill, PhD, is a Research Fellow at Curtin University (School of Physiotherapy). Her research interests relate to pulmonary rehabilitation and exercise training in chronic disease. She is a contributor to The Pulmonary Rehabilitation Toolkit and has presented pulmonary rehabilitation workshops in Canada. Nola Cecins, MSc, is a Senior Physiotherapist at SCGH (Physiotherapy Department) and Curtin University (School of Physiotherapy). Her research interests relate to pulmonary rehabilitation and airway clearance in patients with chronic lung disease. She is a contributor to The Pulmonary Rehabilitation Toolkit and has presented pulmonary rehabilitation workshops throughout Australia.

Sue Jenkins, School of Physiotherapy, Curtin University, GPO Box U1987, Bentley, WA 6845. Email: s.jenkins@curtin.edu.au

ABSTRACT

Pulmonary rehabilitation plays an essential role in the management of symptomatic patients with COPD. The benefits of rehabilitation include a decrease in dyspnoea and fatigue, and improvements in exercise tolerance and health-related quality of life. Importantly, rehabilitation reduces hospitalization for acute exacerbations and is cost-effective. Although most of the evidence for pulmonary rehabilitation has been obtained in patients with COPD, symptomatic individuals with other respiratory diseases have been shown to benefit. In this review we outline a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program (PRP) that would be feasible in most settings. Throughout the review we have specified the minimum requirements for a PRP to facilitate the establishment of programs using limited resources. Recommendations for staffing and other resources required for a PRP are presented in the first section. Exercise training is a focus of the section on program delivery as this is the component of rehabilitation that has the strongest level of evidence for benefit. Program considerations for patients with respiratory conditions other than COPD are described. Different approaches for delivering the education component of a PRP are outlined and recommendations are made regarding topics for group and individual sessions. The problems commonly encountered in pulmonary rehabilitation, together with recommendations to avoid these problems and strategies to assist in their resolution, are discussed. The review concludes with recommendations for evaluating a PRP.

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