Enhance Access to Pulmonary Rehabilitation with a Structured and Personalized Home-Based Program—reabilitAR: Protocol for Real-World Setting

Abstract

Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program—reabilitAR—in Portugal and the strategies to assess its benefits in patients with CRD. The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase (total: 52 weeks, 1 year). The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients’ needs through a structured and personalized home-based program in Portugal.

A qualitative exploration of people living with idiopathic pulmonary fibrosis experience of a virtual pulmonary rehabilitation programme

“…There is some evidence of increased dropout in VPR among older more frail adults [ 30 ], however we observed only one dropout secondary to acute worsening of their symptoms. Ease of accessibility to the programme was highlighted by participants which is in line with current research [ 31 ]. PR is conducted in a group setting and for some this was not lost in the virtual environment, participants still felt as though they were connecting with others.…”

Closing the Gap between Inpatient and Outpatient Settings: Integrating Pulmonary Rehabilitation and Technological Advances in the Comprehensive Management of Frail Patients

“…Although the effects of PR are widely documented, its integration into the comprehensive management of COPD and its accessibility for the patients remains still challenging [ 7 , 8 ]. On the other hand, in recent years, growing evidence emphasized the positive effects of PR in frail patients suffering from disabling conditions including chronic heart disease, metabolic syndrome, musculoskeletal or neurological co-morbidities, and cancer [ 9 , 10 ].…”

Reference Equation of a New Incremental Step Test to Assess Exercise Capacity in the Portuguese Adult Population

“…Cardiopulmonary exercise testing (CPET) is considered the gold standard method used to assess exercise capacity, by providing a measure of the maximum oxygen consumption (VO 2 max), which in turn is the gold standard measure for the assessment of cardiorespiratory fitness (CRF) [4]. Treadmills and cycle ergometers are indicated to assess CRF [1]; however, their use is not always feasible in all settings where rehabilitation programs can be implemented [5], especially in community- [6][7][8] and home-based [9][10][11] programs, because they have high costs and require both specialized instruments and trained personnel [1]. To overcome these limitations, field tests can be more affordable, simple to apply, and better related to patients' demands during activities of daily living [2,12].…”