Does pulmonary rehabilitation alter patients’ experiences of living with chronic respiratory disease? A qualitative study

Abstract

PurposeChronic respiratory disease (CRD) including COPD carries high and rising morbidity and mortality in Africa, but there are few available treatments. Pulmonary rehabilitation (PR) is a non-pharmacological treatment with proven benefits in improving symptoms and exercise capacity, which has not been tested in Africa. We aimed to evaluate the lived experience of people with CRD, including physical and psychosocial impacts, and how these are addressed by PR.Patients and methodsA team of respiratory specialists, nurses, and physiotherapists implemented PR to meet the clinical and cultural setting. PR consisted of a 6-week, twice-weekly program of exercise and self-management education. Forty-two patients were recruited. Qualitative data were collected through interviews with patients at baseline and six weeks post-completion, focus group discussions, ethnographic observations, and brief interviews.ResultsBefore and after PR, a total of 44 semi-structured interviews, 3 focus group discussions, and 4 ethnographic observations with brief interviews were conducted. Participants reported profound problems with respiratory symptoms, functional impairment, wide-reaching economic and psychological impacts, and social isolation. Patients who were debilitated by their condition before PR reported that PR addressed all their major concerns. It was reported that breathlessness, pain, immobility, weight loss, and other CRD-related symptoms were reduced, and social and intimate relationships were improved. Local materials were used to improvise the exercises, enabling some to be maintained at home. Recommendations for future PR programs included patient information to take home as a reminder of the exercises, and to show their families, and the support of a community health worker to help maintenance of exercises at home.ConclusionPR has the potential to restore the physical, mental, and social functioning in patients with CRD, whereas medication has much more narrow effects. PR offers a major new option for treatment of a neglected group of patients.

Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

“…Of the remaining 14 articles, we further excluded one duplicate, 30 one with abstract only and no author contact details, 31 one nonresearch guideline 32 and five that did not meet inclusion criteria. [33][34][35][36][37] Study characteristics Of the six finally included, three studies were conducted in South Africa, [38][39][40] two in Uganda 41,42 and one in Nigeria, 43 and all were published between 2010 and 2018. The studies were focused on the feasibility and acceptability of PR programmes.…”

“…Of these, COPD was the indication for inclusion in 59 participants across three studies. 38,42,43 A further 88 participants had asthma within a single study, 40 61 participants had p-TBLD in the two Uganda studies 41,42 and 67 participants were included in a separate study on PTB during antituberculous treatment 39 (Table).…”

“…Evidence for individualising the exercise regimens of PR programmes was available in three studies, [40][41][42] including the evidence for progression of exercise training loads. For example:…”

“…41 The intervention was performed in groups, but the exercise training was individually prescribed and intensified as the programme progressed. 42 Individual age predicted maximum heart rate (HR max ) was utilised. .…”

Experiences of Pulmonary Rehabilitation in People Living with Chronic Obstructive Pulmonary Disease and Frailty. A Qualitative Interview Study

“…However, people’s experience of multidimensional loss may be accelerated in the context of both COPD and frailty, owing to a combination of respiratory symptom burden and low physiological reserve. The multiple challenges people experience in completing pulmonary rehabilitation ( 43 – 47 ) are also well established. Yet, our study demonstrates how characteristics and correlates of frailty (e.g., low energy, weakness, vulnerability to health events) can create specific challenges to participation.…”