Introduction and objectives Pulmonary Rehabilitation (PR) is defined as a multidisciplinary programme for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy (NICE, 2010). Our service was involved in RCP PR Pilot Accreditation Scheme.
Individuals MRC 2–5, functionally limited by breathlessness are referred to PR (BTS, 2013). There is a wide spread of functional disability and breathlessness for these individuals. Does one approach to PR address the needs of all patients within these broad groupings?
Aims Modifying PR may improve attendance and completion of full PR for patients MRC5.
Methods Following service review, Modified Programme was offered; 2 × Gym Sessions and education. Session one; patients difficulties were discussed. Breathing control techniques, improved posture and lung inflation were demonstrated. Daily home exercises were promoted. Following 2 weeks of homework, the patients were invited to a review. Any improvement in breathlessness and confidence was discussed with the patients offered Full PR where appropriate.
The patient who did not complete full programme continued to attend education. 1 patient attended the first session with no further engagement. 1 patient deferred until June 2016. Qualitative data reports significant benefit.
This modified approach was observed during the RCP site visit. Feedback included the need for feedback to the BTS with regards to greater flexibility with the standards and their future developments as a consequence of observing our modified approach to PR.
What Next? Modification to standard PR offers significant improvement in attendance and completion of PR for patient with significant dyspnoea (MRC5). Could these results be replicated within other PR service?
We continue to offer modified PR and now include MRC4 patients with significant co-morbidities which would otherwise restrict attendance.
National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (CG101). London: NICE, 2010.
British Thoracic Society. BTS guideline on pulmonary rehabilitation in adults. London: BTS, 2013.