Feasibility and effectiveness of a pulmonary rehabilitation programme in a community hospital setting

Royal Devon and Exeter NHS Foundation Trust, Exeter, England, United Kingdom
British Journal of General Practice (Impact Factor: 2.29). 08/2002; 52(480):539-42.
Source: PubMed


Pulmonary rehabilitation programmes run in secondary care have proved to be one of the most effective interventions for patients with chronic obstructive pulmonary disease (COPD).
To assess whether a pulmonary rehabilitation programme, similar to that run in secondary care, could be established in a primary care-run community hospital and whether it could achieve similar benefits in patents with moderately severe COPD.
Uncontrolled prospective intervention study
A primary care-run community hospital.
Thirty-four patients with COPD aged between 5 and 80 years of age (mean = 70years) with a forced expiratory volume (FEV1) of 30 to 50% (mean = 40%) predicted were enrolled in a programme established in the activities room at Honiton Community Hospital. Patients were assessed at the start, on completion of the programme, and six months after completion, using spirometry, shuttle-walking distance, and short form-36 (SF-36) and chronic respiratory questionnaire (CRQ) scores.
All but one patient completed the programme. There were significant improvements in the walking distance (by a mean of 100 m), in the SF-36, and in all domains of the CRQ. There was no significant change in the FEV1 or forced vital capacity.
Pulmonary rehabilitation programmes can be run in community hospitals. They appear to be as effective as those run in secondary care and patients may find them easier to access.

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    • "These programs can safely run during hospital admission in outpatient units [29] and in community hospitals as well [60]. PR is grounded on physical exercise programs that aim to reduce symptoms (especially dyspnoea) and improve lung functions in terms of exercise tolerance, force and strength [24]. "
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    ABSTRACT: COPD has significant extrapulmonary effects as weight loss, nutritional abnormalities, and skeletal muscle dysfunction. Pulmonary rehabilitation (PR) programs are beneficial to COPD in order to improve exercise capacity, muscle force, symptoms, and health-related quality of life.
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    • "Although PR has been shown to be effective in managing symptoms and reducing hospital admissions, poor participation and adherence are a current problem among outpatient programs [18]. Factors include difficulty travelling to the program's location [19] [20] [21] [22], inconvenience of hospital attendance [23], or difficulty accessing programs [24]. Accessing programs is especially problematic for those who live in rural and remote areas [25]. "
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    ABSTRACT: Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting real-time pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants' perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant's oxygen saturation and heart rate with the data set received at the therapist's remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman's limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-to-face methods.
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    Preview · Article · Aug 2002 · British Journal of General Practice
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