1. PULMONARY REHABILITATION.
Judith Colligan

2. Contents. Aims of rehabilitation Definition Development of disability
Components of pulmonary rehabilitation
Audit of Raigmore service
Community rehabilitation
Patient follow up
Home exercise programmes

3. Aims of pulmonary rehabilitation.
Restores medical, emotional, social and vocational potential.
Optimises functional capacity.

4. Definition.
“ Pulmonary rehabilitation provides a comprehensive approach aimed at stabilising and reversing the physiopathology and psychopathology of chronic pulmonary disease, to obtain control and relief of symptoms and complications and to achieve optimal ability to carry out the activities of daily living.” Donner, 1989.

5. Development of disability.
Decades to develop
Reduction in physiological capacity resulting from pathological damage.

6. Downward spiral of disability.

7. Stages of rehabilitation.
Referral
Selection
Assessment
Rehabilitation
Evaluation
Maintenance and follow up

8. Referral. GP’s Consultants Physiotherapists Practice nurses
Other Health Care Professionals
Health professionals referring patients to pulmonary rehab should have a basic knowledge about programme
Offered as a fundamental treatment not an optional extra
Patients hospitalised for acute exacerbation of COPD should be offered pulmonary rehabilitation at hospital discharge to commence within 1 month of discharge

9. Selection
COPD
MRC score > 3, although new guidelines state that patients with level 2 who are functionally limited should be referred
FEV1 < 50% predicted (not as relevant as MRC score)
Exclude those with unstable angina/ recent cardiac event / poor motivation (difficult to determine motivation)
Bronchiectasis, unlike with CF patients there is no evidence of cross infection
Pre/post lung surgery
Fibrosing alveolitis (more research needed)
Asthma, in stable asthma

10. Assessment. FEV1/FVC (optional) – don’t use anymore Oxygen saturations
BORG scale
Quality of life questionnaires –
Hospital Anxiety and Depression (HAD)
Breathing Problems Questionnaire (BPQ)- not used anymore
Chronic Respiratory Questionnaire (CRQ)
Shuttle test/ 6 minute walking test

11. Components of rehabilitation.
Exercise training
Relaxation
Disease education

12. Exercise training. Aerobic
Strength – major muscle groups, weights individualised. (2-4 sets, reps), BTS, 2013
Respiratory muscle training? – Not recommended as routine part of pulmonary rehab, BTS, 2013
Walking, step ups, STS, throwing ball, carrying medicine ball, biceps,triceps, wall press, squats, calf raises

13. Disease education. Pathology/Disease Management
Breathing Exercises/ Clearance Techniques
Relaxation/ Energy Conservation/ADL’s
Medication
Diet
Inhaler techniques
Smoking Cessation
MHLT

14. Patient Information Packs
Information Leaflet about Pulmonary Rehab
Living With Lung Disease Booklet
Home Exercise Diary
Energy Conservation
When to Call Your Doctor
Relaxation Advice

15. Evaluation.
Referrals – 18% consultant, 59% GP, 15% practice nurses, 4% physiotherapists, 3% respiratory nurse
37% completed programme
94% found the class beneficial

16. Evaluation. CRQ Shuttle test 86% improved HADS 62% improved
Dyspnoea 81% improved
Fatigue 53% improved
Emotional Function 62% improved
Mastery 81% improved
Shuttle test 86% improved
HADS 62% improved

17. Maintenance. Hospital based classes
Community classes - Cheerful Chesters,
Maintenance classes, elsewhere?

18. Patient follow-up. Six month review for first 2 years post class
Re attendance of class if required
Telephone contact

19. Pulmonary Rehab in patients homes

20. Outcome Pre Post Diff P1 200 330 130 P2 250 50 P3 120 190 70 P4 140
240
100
Mean
165
252 88 SD 41 58 35

21. Information Resources
BTS Guideline on Pulmonary Rehabilitation in Adults, September 2013
Quality Improvement Scotland, COPD – Clinical Standards, 2010