Pulmonary Rehabilitation

Download the IMPRESS guide to pulmonary rehabilitation December 2011.

Executive summary

Pulmonary rehabilitation (PR) reduces morbidity, mortality and hospital attendances in people with COPD disabled by their disease.
PR should receive commissioning priority given its proven clinical and cost effectiveness and relative value compared to many of our other interventions for COPD.
The more components of the COPD pathway working together in an integrated multi-faceted programme, including an interface with self-management support, quit smoking support and oxygen assessment, the more likely there is to be a positive effect.
This paper reviews the evidence, explains what PR is, how it works, its value and why it should be com- missioned.
It supplements the Commissioning Pack for COPD to be issued by the DH England, including a section on PR (due early 2012).
It answers the questions asked by commissioners who may have no current service, a service with insufficient capacity, one that does not meet patient’s expectations, or one that is failing to achieve accept- able completion rates.

Other resources from IMPRESS include

Principles, Definitions & Standards for Pulmonary Rehabilitation supported by IMPRESS in consultation with British Association of Occupational Therapists (BAOT), Association of Respiratory Nurse Specialists (ARNS) and Association of Chartered Physiotherapsits in Respiratory Care (ACPRC)

This document includes 4 standards with markers of good practice:

Standard 1 A rehabilitation programme must contain individually prescribed, physical exercise training together with lifestyle and self-management advice.
Marker of good practice Written prescriptions of endurance and strength exercise training at the highest tolerated intensity and evidence of increments with progress.

Standard 2 The programme should be delivered by a multi-disciplinary team and include two supervised sessions per week for at least four weeks. Further home training should be encouraged.
Marker of good practice Diversity of team membership, staffing ratios and existence of training diaries

Standard 3 Individual progress should be assessed by the use of appropriate assessment and outcome measures (usually health status and functional exercise capacity)
Marker of good practice Records of individual patient progress in all cases

Standard 4 There should be evidence of programme quality control and improvement.
Markers of good practice There should be records of patient attendance and drop out, patient satisfaction questionnaires and audit of effectiveness. The presence of appropriate safety measures, including staff resuscitation training and availability of oxygen.

Hospital and integated service view

Webcast from Dr Louise Restrick at the inaugural IMPRESS conference showing how her team increased completion rates from the national average of 50% to 92%. An outreach model of integration, the Whittington model

This model from NHS Islington is also available as a NICE example of shared learning Introduction of pulmonary rehabilitation programme in primary care in accordance with COPD guidance

General practice view
Webcast from Dr Rupert Jones at the inaugural IMPRESS conference: Care closer to home. The models of pulmonary rehabilitation Dr Jones estimates that if you assume a 2% prevalence of diagnosed COPD and 30% of those will benefit from PR, then in a population of 250,000, 1500 will need pulmonary rehabilitation, and a GP with 2000 patients may have 40 patients with COPD of whom 12 will need referral to PR. It is therefore important to create models of provision that match this need. He gives examples.

From Primary Care Respiratory Society (PCRS-UK)

Best practice

Opinion sheet

NICE