Background
Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease.
Methods
The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations.
Recommendations
The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence).
Conclusions
These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
Background and Purpose. The purpose of this case report is to describe physical therapy to improve the balance and ambulation of a 16-yearold patient with attention impairment following intracranial hemorrhage. Case Description. The patient initially had frequent losses of balance, especially in distracting environments, due in part to decreased attention. He was managed with a balance and ambulation training program that incorporated the principles of cognitive rehabilitation for attention impairments. Outcomes. Following 11 weeks of outpatient therapy, the patient returned to independent ambulation at school without losses of balance. Discussion. Research is needed to determine the interaction between balance and attention in patients with brain injury and effective treatment for patients with decreased balance related to attention impairments. [Tappan RS. Rehabilitation for balance and ambulation in a patient with attention impairment due to intracranial hemorrhage. Phys Ther. 2002;82:473-484.]
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