The untapped potential of pulmonary rehabilitation

Pulmonary rehabilitation (PR) is a long-established, cost-effective intervention known to improve symptoms and quality of life for those living with chronic lung disease. Therefore, why does it remain underutilized in clinical practice?

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Despite the benefits seen with pulmonary rehabilitation (PR), it remains underutilized in clinical practice, with fewer than 2% of COPD patients enrolling.1,2

The basics of pulmonary rehabilitation

How do we define PR? The supervised program integrates health education, exercise training, and breathing techniques for people living with conditions such as asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and pulmonary hypertension. Individuals enrolled in PR programs receive care from a team of healthcare providers, who can personalize the plan based on a patient’s lung health, age and fitness levels. Alongside the educational and physical aspects of the program, individuals also receive psychological counseling to aid any depression, anxiety or stress they may be suffering with.3

Barriers to enrolling

So why is there such a small proportion of individuals enrolling in PR? A recent survey in 1685 respondents (73% female) with self-reported chronic lung disease in 29 countries (71.1% of respondents from the USA) discovered that roughly two-fifths of patients report that their physician had never informed them about PR, or of the benefits it can offer for people with chronic lung disease.2 Unfortunately, across the globe, training in PR is neither compulsory nor standardized, and so knowledge of interventions can be limited. Because of this, suboptimal physician awareness of PR can be a critical barrier to patient referral.4

Beyond awareness there are additional barriers. For instance, 60% of patients reported experiencing challenges to taking part in PR, with nearly one-fifth facing logistical challenges such as lack of an available PR service or no insurance coverage.2 Inadequate payer awareness and knowledge of PR may contribute to a deficit in funding for PR programs. With little funding, PR programs can be insufficient in meeting patient needs or have inadequate staffing, equipment, or infrastructure resources.4

Patient perceptions

Irrespective of these barriers, patients in this study retained a positive opinion about PR. Of the 1685 patients who participated in a program reported improvements included mood or sense of wellbeing (48.6%), physical functioning (75.8%), knowledge about their condition (52.4%), social functioning (28.9%) and control of symptoms (46.0%). No participants made any negative comments or advised against participation in PR programs.2 Evidently patients are eager to learn about and participate in PR but are constrained by current accessibility or awareness challenges.2

Overcoming the challenges

There is a clear demand for more formal, standardized PR training for healthcare professionals. With the incorporation of training requirements into national training curriculum documents, and syllabi collaboratively developed by educational authorities in respiratory care, we could equip physicians with the required knowledge to routinely implement PR programs in their clinical practice. In addition, transparency, documentation and communication by clinicians regarding the outcomes and cost-effectiveness of PR to payers is vital to ensuring funding for programs is increased.4

Incorporating suggestions for improvement from the end user is equally essential to harnessing the potential of PR. Those who have previously participated in programs recommended a number of potential improvements. These included; having more PR facilities across locations to minimize travelling distance; having lower ‘out-of-pocket’ costs; programs with a longer duration or the opportunity to partake in two PR programs annually; having the choice for PR sessions during evenings or at weekends.

Participants also highlighted the value of program personalization depending on an individual’s condition.The benefits of PR are already well-established across multiple therapy areas if the barriers to PR accessibility and adoption can be overcome.4

References

  1. Spruit MA et al. Am J Respir Crit Care Me 2013; 188(8): e13–64.
  2. Rochester CL et al. ERJ Open Res 2018; 4: 00085-2018.
  3. National Heart, Lung and Blood Institute. Available at: https://www.nhlbi.nih.gov/health-topics/pulmonary-rehabilitation. Accessed: May 2019.
  4. Vogiatzis I et al. Eur Respir J 2016; 47: 1336-1341.

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