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Establishing a pulmonary rehabilitation programme
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Michael D.L. Morgan, Sally J. Singh
Pulmonary rehabilitation is one of the most effective treatments for people with chronic lung disease. Unfortunately, only a minority of patients who would benefit are ever offered a referral to a programme. Facilities for pulmonary rehabilitation vary by country but generally programme capacity is inadequate in terms of number and size of facilities. In spite of the recognized benefits of pulmonary rehabilitation, many healthcare systems still fail to commission adequate provision. This deficiency may be due to economic constraints or lack of understanding of the benefits. This generally means that commissioners (payers) may need to be persuaded of the benefits in order to encourage them to provide a service. A good business case is necessary to demonstrate that pulmonary rehabilitation not only provides individual benefits in terms of exercise performance and quality of life but delivers good outcomes for the served population. Most commissioners will also want to appreciate that there are additional societal and health economic benefits particularly in terms of hospital admissions and possibly mortality. When making a business case it will be important to understand both the geography and the presence of inequalities in the local population.
Pulmonary Rehabilitation: Current Status and Future Trends
Published in Mary C. Singleton, Eleanor F. Branch, Advances in Cardiac and Pulmonary Rehabilitation, 2018
SUMMARY. Pulmonary rehabilitation is a relatively new approach to the treatment of patients with chronic lung disease. These programs are designed to maximize the functional capabilities of such patients through a formal program of education, exercise, physical therapy, respiratory care and other modalities. Studies to date strongly suggest that pulmonary rehabilitation programs reduce morbidity (including medical costs) and improve the functional status of participants. However, programs are few in number and serve only a small fraction of the potential population. Moreover, reimbursement is often suboptimal. Research programs studying the cost effectiveness of various components of pulmonary rehabilitation urgently are needed to address these issues. From these will come guidelines and certification procedures that will allow more widespread development of truly effective programs; specifically, programs that will provide significant functional improvement at only a fraction of the resultant productivity increases and health care cost savings.
Pulmonary rehabilitation
Published in Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay, COPD in Primary Care, 2018
The future for pulmonary rehabilitation seems to be assured. As was mentioned at the beginning of this chapter, there has been a massive increase in the number of research studies conducted in the last few years, and many of the findings have already found their way into the mainstream classes.
Tele-rehabilitation for patients who have been hospitalised with Covid-19: a mixed-methods feasibility trial protocol
Published in Physical Therapy Reviews, 2022
Lucy Hyde, Andrew J. Simpson, Marion Nettleton, Joanne Shepherdson, Clare Killingback, Phil Marshall, Michael G. Crooks, Angela Green
The principle function of pulmonary rehabilitation is to improve symptoms of patients with chronic respiratory conditions. A standard multidisciplinary pulmonary rehabilitation programme consists of 12 face-to-face group sessions, over 6-12 weeks, featuring educational, social and physical elements, which aim to improve numerous outcome measures (i.e. exercise capacity, quality of life, respiratory symptoms and anxiety and depression) [10]. Whilst the body of evidence for pulmonary rehabilitation for respiratory conditions such as COPD is strong [10], the extent to which a Covid-19 population would benefit from pulmonary rehabilitation is currently unknown. Furthermore, the body of evidence for remotely delivered pulmonary rehabilitation or tele-rehabilitation is much smaller, with heterogeneity surrounding the rehabilitation protocols [11].
Juggling the management of everyday life activities in persons living with chronic obstructive pulmonary disease
Published in Disability and Rehabilitation, 2022
Rina Juel Kaptain, Tina Helle, Anders Kottorp, Ann-Helen Patomella
As the goals of pulmonary rehabilitation are “minimizing symptom burden, maximizing exercise performance, promoting autonomy, increasing participation in everyday activities, enhancing (health-related) quality of life, and effecting long-term health-enhancing behavior change” [2], we as health professionals must remember to address all the elements and not only the symptoms and exercise parts. Exercise training to improve skeletal muscle function does lead to gains in exercise capacity [2,26,71], but transfer to ADL does not automatically occur [72–74]. People living with COPD should be offered support in making more deliberate choices and prioritise their everyday life activities, and thereby continue to participate in valued or engaging activities despite their disease-related limitations [75,76].
Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea
Published in Expert Review of Respiratory Medicine, 2022
Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma
The diagnostic evaluation for persistent dyspnea is only completed after evaluating the clinical response to a therapeutic intervention. In addition to instituting medical treatments for a specific diagnosis, there are some general approaches that can have clinical benefit regardless of the underlying disease process. For individuals with chronic lung disease, pulmonary rehabilitation effectively reduces shortness of breath while improving quality of life. For those not qualifying for pulmonary rehabilitation we usually refer to wellness programs that offer weight loss interventions and a tailored physical training program that includes muscle strengthening and gradual aerobic training. Respiratory retraining by speech therapy can be helpful for patients with breathing perception disorders, yet there is insufficient clinical data across published studies to determine its overall efficacy rate [59].