A systematic review of the content and delivery of education in pulmonary rehabilitation programmes

Roberts, Nicola; Kidd, Lisa; Kirkwood, Kim; Cross, Jane; Partridge, Martyn R

doi:10.1016/j.rmed.2018.11.002

Cited by 26 publications

(20 citation statements)

References 43 publications

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“…Our previous systematic review showed that in the published literature several topics were not featured and there were few tools used to evaluate the effectiveness of education. 22 This cross-sectional survey provides data on 64% of the PR sites across Scotland (response rate of 81.8%, 9/11 respondents), includes data from 17 PR teams across Scotland. This survey set out to examine what is delivered in practice, it is the first to show in detail what educational content is delivered and who is involved in the teams and delivery of education within PR across Scotland.…”

Section: Discussionmentioning

confidence: 99%

How is the education component of pulmonary rehabilitation delivered in practice––Is it patient‐centred?

Roberts

Kidd

Kirkwood

et al. 2021

Clinical Respiratory J

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Pulmonary rehabilitation (PR) is a crucial part of the management of respiratory disease, mostly delivered to those with COPD although this has widened in recent years to encompass bronchiectasis, interstitial lung disease (ILD) and asthma. 1,2 PR is defined as 'a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviours'. 3 Theoretically, PR should equip participants with the right tools to take control of their condition, which should include the acquisition and use of self-management

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Section: Discussionmentioning

confidence: 99%

How is the education component of pulmonary rehabilitation delivered in practice––Is it patient‐centred?

Roberts

Kidd

Kirkwood

et al. 2021

Clinical Respiratory J

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“…82 As PR includes exercise training under the direction of a health-care professional, this may address exertional breathlessness-related cognitive and emotional factors, even when CBT is not intentionally prescribed. There is significant overlap in components of CBT interventions listed in the included studies (eg,education on anxiety and COPD; education about depression and inactivity in COPD; distraction, relaxation, and breathing techniques; self-monitoring and goal setting) and common content of the education component of pulmonary rehabilitation (anxiety/depression and panic control management; symptom management including breathing strategies 83 ). In both center-or home-based PR programs, 84 individualized education and goal setting occurs during the supervised exercise sessions.…”

Section: Discussionmentioning

confidence: 99%

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

Williams¹,

Johnston²,

Paquet³

2020

COPD

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Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/ usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from −0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from −0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resourceintensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.

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“…Six sessions will be conducted by a multidisciplinary team. Based on the literature and previous experience, it is anticipated that some themes will need to be addressed [42, 81–84] however, the component will be tailored to patients and caregivers’ needs. A detailed description of these sessions can be found in Fig.…”

Section: Methodsmentioning

confidence: 99%

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

et al. 2019

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Background Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. Discussion This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ). Electronic supplementary material The online version of this article (10.1186/s12889-019-7045-1) contai...

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A systematic review of the content and delivery of education in pulmonary rehabilitation programmes

Cited by 26 publications

References 43 publications

How is the education component of pulmonary rehabilitation delivered in practice––Is it patient‐centred?

How is the education component of pulmonary rehabilitation delivered in practice––Is it patient‐centred?

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis

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