Future of Pulmonary Rehabilitation
4 June, 2022 | DelveInsight
“Pulmonary rehabilitation is a comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies that include but are not limited to, exercise training, education, and behavioral changes, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health enhancing behaviors”, says Dr. Neil James, University of Leicester, United Kingdom. The non-pharmacological outpatient program is employed in chronic respiratory patients, mainly COPD, as a part of standard management and health maintenance. For gaining successful outcome, there are few essential components which are required- exercise training, psychological counseling, nutritional evaluation and counseling, inspiratory muscle training, and education, including proper use of prescribed drugs. Summarily, in this rehabilitation program patient assessment by health care professional is important in order to have quality of life evaluation, dyspnea assessment, nutrition check and occupational status judgement. Additionally, endurance and resistance training are imperative parts of the program. The method of delivery may vary in accordance with individual attributes and the exercise plan is progressed based on personalized growth. Assuring the quality through trained health care professionals is of the essence for ensuring positive outcome of the program. There may be variations in the approach based on the type of pulmonary rehabilitation (PR) program being used, namely- Centre-based Comprehensive PR, Home-based and tele-rehabilitation and Virtual-group PR.
The impediment, to the use of pulmonary rehabilitation program, which ensued the pandemic restrictions in 2020, caused a shift in the usage trends of Centre-based, Home-based & Virtual group programs. A study discussed by Dr. Anne E. Holland from Monash University (Australia) suggested that during pre-Covid times, Centre-based approach was the one being used the most (around 85%) which abruptly dropped to 7% in 2020 whereas the share for telephone based PR increased from 15% to 87% for the same time periods. Moreover, virtual group based PR, which was not offered previously, gained 6% proportion of patients in 2020.
The share of patients, in 2021, have started normalizing through decline in telephonic PR and increase in Centre-based approach patient share when compared to 2020 numbers. The trend is likely to continue in 2022.
Specifically, in patients with COPD, attendant problems occur such as cardiovascular disease, frailty, obesity to name a few. The exercise training improves pulmonary ventilation, circulation, cardiac pump and capillarization, which calls for the use of these programs in eligible patients. However, the implementation has certain challenges which are as follows:
- Training and support of healthcare professional needs to be provided for the best outcome.
- The patients who experience exacerbation have lesser inclination to join back the program, this significantly affects the adherence
- The challenges related to funding and reimbursement persists which may prevent accessibility for all eligible patients.
The benefits of pulmonary rehabilitation were observed when considered endpoints were exercise tolerance, symptoms of dyspnea, endurance, and quality of life. It can help improve how much exercise you're able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing.
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