Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report

Anne E Holland, Narelle S Cox, Linzy Houchen-Wolloff, Carolyn L Rochester, Chris Garvey, Richard ZuWallack, Linda Nici, Trina Limberg, Suzanne C Lareau, Barbara P Yawn, Mary Galwicki, Thierry Troosters, Michael Steiner, Richard Casaburi, Enrico Clini, Roger S Goldstein, Sally J Singh, Anne E Holland, Narelle S Cox, Linzy Houchen-Wolloff, Carolyn L Rochester, Chris Garvey, Richard ZuWallack, Linda Nici, Trina Limberg, Suzanne C Lareau, Barbara P Yawn, Mary Galwicki, Thierry Troosters, Michael Steiner, Richard Casaburi, Enrico Clini, Roger S Goldstein, Sally J Singh

Abstract

Pulmonary rehabilitation is a highly effective treatment for people with chronic lung disease but remains underused across the world. Recent years have seen the emergence of new program models that aim to improve access and uptake, including telerehabilitation and low-cost, home-based models. This workshop was convened to achieve consensus on the essential components of pulmonary rehabilitation and to identify requirements for successful implementation of emerging program models. A Delphi process involving experts from across the world identified 13 essential components of pulmonary rehabilitation that must be delivered in any program model, encompassing patient assessment, program content, method of delivery, and quality assurance, as well as 27 desirable components. Only those models of pulmonary rehabilitation that have been tested in clinical trials are currently considered as ready for implementation. The characteristics of patients most likely to succeed in each program model are not yet known, and research is needed in this area. Health professionals should use clinical judgment to determine those patients who are best served by a center-based, multidisciplinary rehabilitation program. A comprehensive patient assessment is critical for personalization of pulmonary rehabilitation and for effectively addressing individual patient goals. Robust quality-assurance processes are important to ensure that any pulmonary rehabilitation service delivers optimal outcomes for patients and health services. Workforce capacity-building and training should consider the skills necessary for emerging models, many of which are delivered remotely. The success of all pulmonary rehabilitation models will be judged on whether the essential components are delivered and on whether the expected patient outcomes, including improved exercise capacity, reduced dyspnea, enhanced health-related quality of life, and reduced hospital admissions, are achieved.

Keywords: access and evaluation; chronic obstructive/rehabilitation; healthcare quality; lung diseases/rehabilitation; pulmonary disease.

Figures

Figure 1.
Figure 1.
Essential components of pulmonary rehabilitation. Essential components of the pulmonary rehabilitation model were identified through a Delphi process. An essential component was defined as having a median score ≤2 (strongly agree or agree it is essential) and high consensus (interquartile range, 0).
Figure 2.
Figure 2.
Desirable components of pulmonary rehabilitation. Desirable components of the pulmonary rehabilitation model were identified through a Delphi process. A desirable component was defined as having a median score ≤2 (strongly agree or agree) but as having some variation in scores (interquartile range, 1). ACT = airway clearance techniques.

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