Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

Alda Marques, Cristina Jácome, Patrícia Rebelo, Cátia Paixão, Ana Oliveira, Joana Cruz, Célia Freitas, Marília Rua, Helena Loureiro, Cristina Peguinho, Fábio Marques, Adriana Simões, Madalena Santos, Paula Martins, Alexandra André, Sílvia De Francesco, Vitória Martins, Dina Brooks, Paula Simão, Alda Marques, Cristina Jácome, Patrícia Rebelo, Cátia Paixão, Ana Oliveira, Joana Cruz, Célia Freitas, Marília Rua, Helena Loureiro, Cristina Peguinho, Fábio Marques, Adriana Simões, Madalena Santos, Paula Martins, Alexandra André, Sílvia De Francesco, Vitória Martins, Dina Brooks, Paula Simão

Abstract

Background: Pulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.

Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy - fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.

Discussion: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases.

Trial registration: The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ).

Keywords: Chronic respiratory diseases; Cost-benefit; Education and psychosocial support; Exercise training; Primary healthcare.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Community-based pulmonary rehabilitation – exercise training component. 6MWT – 6-min walk test; Wpeak - work peak; HRmax – maximum heart rate; 1-RM – 1 repetition maximum; 10-RM – 10 repetition maximum; N/A – not applicable. Consent from participants was obtained to publish the data
Fig. 2
Fig. 2
Community-based pulmonary rehabilitation – education and psychosocial component
Fig. 3
Fig. 3
Exercise options and physical activity recommendations for patients to perform at home

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Source: PubMed

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