Physical exercise during acute exacerbations of chronic obstructive pulmonary disease: Australian physiotherapy practice

Abstract

Evidence supports an important role for pulmonary rehabilitation (PR) after acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, the role of physical exercise during hospitalisation is less clear. This study evaluated Australian physiotherapy practice and clinical perspectives regarding exercise and physical activity for patients with AECOPD. A national survey of 123 Australian public hospitals was conducted from 2016 to 2017 using a purpose-designed survey measuring self-reported physical exercise prescription, objective measure use, referral patterns and factors influencing service delivery. The response rate was 72% (88 hospitals; 176 physiotherapists). Most physiotherapists (92%) prescribed physical exercise frequently for patients with AECOPD and perceived their role to be important (81%). The most commonly prescribed modalities were ground walking (94%), sit-to-stand (89%) and non-equipment-based lower limb strengthening (79%). Only 32% of respondents offered physiotherapy evaluation during post-discharge outpatient clinic appointments at their hospital. While 71% of respondents indicated they frequently referred patients to PR after AECOPD, rates were significantly higher in those with more cardiorespiratory experience (82%) than those with less experience (66%; p = 0.026). Australian physiotherapists frequently prescribe simple physical exercise modalities for patients with AECOPD. PR referral rates appear influenced by clinician experience, which may need consideration in future remedial strategies.

Airway clearance techniques for patients experiencing acute exacerbations of chronic obstructive pulmonary disease in the Republic of Ireland

“…Differences between populations and pathophysiology of acute exacerbations, however, render it difficult to determine whether such findings would translate to people with AECOPD. Further enquiry into this area of practice would be of benefit to clinicians and patients, particularly in light of a recent study [26] that showed Australian physiotherapists frequently prescribe physical activity for patients with AECOPD, often in conjunction with huffing and coughing. This survey also showed referrals to pulmonary rehabilitation after discharge were very high, in-keeping with Australian guidelines [27] recommending that patients participate in pulmonary rehabilitation within two weeks of hospital discharge.…”

Acute exacerbations of chronic respiratory disease: Progress and opportunities

“…Many, but not all, of these papers pertain to patients with acute exacerbations of chronic obstructive pulmonary disease, perhaps reflective of the ongoing challenges that acute healthcare providers face to optimally manage this patient group. Read the whole collection and you will gain valuable insights spanning a diverse range of study designs, exploration of issues via quantitative and qualitative methodologies, focused reports of physiotherapeutic practices from different countries across the globe, 5,6 updates regarding instrument validation (De Morton Mobility Index) for use in the acute hospital environment, 7 evaluations of biomarker utility 8 and clinical stratification 9 during acute exacerbations of interstitial lung disease and exploration of issues affecting rates of pulmonary rehabilitation uptake in the period after acute respiratory exacerbations. 10,11 Suffice to say, whether you are a clinician, researcher, healthcare policy maker or an individual affected by chronic respiratory disease, we hope you will find something that will appeal to your interests within this special collection.…”