Pulmonary rehabilitation and respiratory outreach services

1
Pulmonary rehabilitation and respiratory
outreach services

• Post Acute Care Services
• Prince of Wales Hospital
• Anne-marie Boxall

2
Outline

• Pulmonary rehabilitation study
• Study tour
• BTS Winter Meeting
• Outreach services UK and Ireland
• Community based respiratory care- the future
• Acknowledgements
• NSW Physiotherapists Registration Board and Ian
  Collier Memorial Scholarship 2003

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Problem

• COPD- burden of disease
• Pulmonary rehabilitation
• Definition
• Evidence
• So whats the problem?

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Hospital vs Home

• Hospital, outpatient, home
• Exercise tolerance
• Oxygen use
• Cardiac status
• Anxiety, depression, panic attacks
• Co-morbidities
• Transport issues

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Previous studies

• 2 truly home based RCTs
• Busch and McClements (1988)
• Small sample size
• Hernandez et al (2000)
• Exclusions
• Others

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PACS RCT

• Design
• Cross over RCT
• Controls- delayed start
• Non-blinded
• Objectives
• Exercise tolerance
• Quality of life
• Perception of breathlessness

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Patient selection

• COPD
• Over 60 years
• Housebound
• Dyspnea
• Stable symptoms over 2 weeks
• Unable to access hospital programme
• Living locally
• Motivated to exercise

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Intervention

• 12 week home-based programme
• Multi-disciplinary
• Graded walking and arm exercises
• Education sessions
• Supervised weekly
• Exercise diary

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Outcome measures

• Baseline measures
• 6 minute walk test (6MWT)
• St. Georges Respiratory Questionnaire
• Borg scale of perceived breathlessness

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Baseline characteristics

• Mean age 76 years (62-92 years)
• 55 on home oxygen
• Mean FEV1 38 predicted
• No difference in baseline characteristics
• Exclusions

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Exercise tolerance
p0.023
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Quality of life
p0.024
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Symptoms
p0.210
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Impact
p0.024
15
Activity
p0.241
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Breathlessness
p0.020
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Discussion

• First study to demonstrate benefits for elderly,
  housebound severe COPD
• Compliance
• Admissions
• Comparison with hospital based

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Study findings

• Home- based pulmonary safe and effective
• Improved exercise tolerance, quality of life and
  breathlessness
• Provides equity in access to care
• Expansion warranted

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Study tour

• Objectives
• Present study results at BTS
• Visit UK/ Ireland centres
• Areas of improvement
• Advance research agenda

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Visits

• The Royal Liverpool Hospital, ACTRITE Team,
  Liverpool, UK
• Beaumont Hospital, COPD Outreach Team, Dublin,
  Ireland
• Health Care at Home, Southampton and Southampton
  General Hospital, UK
• BTS Winter Meeting- London

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What can we do better?

• NSW leaders in post-acute care, respiratory
  outreach and pulmonary rehabilitation
• Respiratory clinics
• Structured post-acute care
• Transport services for pulmonary rehabilitation

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The future

• Community based services and equity
• HITH services
• Research agenda
• Anxiety
• Pulmonary rehabilitation and cost effectiveness