Post exacerbation Pulmonary Rehabilitation: is this a changing population?
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Published on: November 8, 2013
Chaplin Emma1, Ward Sarah1, Daynes Enya2
1Centre for Exercise and Rehabilitation Science, Pulmonary Rehabilitation Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP UK.
Introduction:
Post-exacerbation pulmonary rehabilitation is a cost-effective, evidence-based intervention offered to patients admitted to hospital. Evidence from randomised controlled trials and meta-analyses demonstrates that early PR following exacerbation significantly improves exercise tolerance and health-related quality of life, while reducing hospital readmission rates and, in some cases, mortality. Despite strong guideline recommendations, uptake remains low due to barriers such as limited referral, patient frailty, and access issues.
Design:
An observational, cross sectional service evaluation of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD). 1315 patients were assessed by the COPD nursing team at the University Hospitals of Leicester NHS Trust and offered pulmonary rehabilitation as part of the routine care bundle.
Main Clinical Findings:
A needs analysis was performed to analyse if there were any predictors to identify those not appropriate for pulmonary rehabilitation or correlations between demographics and those not appropriate.
Main Outcomes:
The majority of patients (48%) declined a referral to PR with only 31% being referred. Readmission to hospital, use of oxygen therapy (both ABOT and LTOT), MRC, Frailty, age and FEV1 showed statistically significant associations with referral to PR; however, the strength of these associations differed. Bonferroni post hoc analysis of the multiple comparisons revealed a significant mean difference in frailty, MRC, LTOT, readmission & age (p = 0.033) was found between individuals who declined the referral and those for whom the referral was deemed not appropriate.
Conclusions:
Several variables were identified as being associated with patients considered not appropriate for referral to PR, with the strongest associations observed for MRC, frailty and age. These along with readmission and oxygen use had significant differences between those that had a referral to PR and those not appropriate. Despite changes in the patient population, PR remained suitable for most patients (79%). The higher rate of patient refusal compared with clinical unsuitability indicates that optimising referral timing and engagement may be more important than reconsidering eligibility criteria.
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