Patient assessment and selection for pulmonary rehabilitation

Abstract

Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co‐morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of ‘responsiveness to PR’, to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health‐related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self‐efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.

Pulmonary Rehabilitation Reduces Subjective Fatigue in COPD: A Responder Analysis

“…Several studies have already reported that fatigue increases in patients with COPD, despite optimal COPD care [13,19,51,52]. Therefore, these findings emphasize that complaints of mild or severe fatigue may be a reason for referral to PR [53]. In total, 30 patients showed an increase in level of fatigue following PR (Figure 1).…”

“…This study investigates fatigue in COPD, a patient-initiated and clinically relevant topic, that despite the high prevalence (and relevance) of fatigue has been neglected in research [12,53]. All patients underwent a broad health status assessment (including anxiety and depression) that resulted in an individualised treatment plan followed by an interdisciplinary PR programme.…”

“…Our results show that an interdisciplinary PR programme reduces fatigue in patients with COPD, in which usual care (optimal COPD care) does not succeed. To date, a holistic and strongly individualised approach seems to be the most appropriate manner to treat fatigue in COPD because of its multifactorial nature [8,15,53]. Not only an impaired exercise tolerance or high symptom burden, but also severe fatigue may be an indication for PR.…”

Optimizing health in chronic lung diseases: What did we learn from the experts in pulmonary rehabilitation?

“…The identification of which patients may benefit the most would help to make the best use of the limited places available for rehabilitation. The review by Rochester addresses the selection of patients for PR. While there are no clear identifiable characteristics that predict those who will be responsive to PR, symptoms of dyspnoea, fatigue and exercise intolerance may be good indicators for referral.…”

Chronic respiratory diseases: The dawn of precision rehabilitation

“…Thus, the demonstration of long‐term clinical efficacy and favourable cost–benefit analysis for such specialized PR programmes becomes important. The comprehensive reviews by Rochester and Amstrong and Vogiatzis provide clear directions on how best to select patients in order to align their needs with the most appropriate set of interventions, including personalized exercise training. It would seem that traditional PR referral criteria based mainly on individual assessments of dyspnoea, fatigue and exercise intolerance are still appropriate and have stood the test of time.…”