Exploring a physiotherapy well‐being review to deliver community‐based rehabilitation in patients with pulmonary hypertension

Abstract

Background Highly structured, supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. Despite evidence of the effectiveness of community-based rehabilitation in other cardiopulmonary diseases, there are limited data in patients with pulmonary hypertension. Methods This prospective study evaluated the intervention of a physiotherapist well-being review in patients with pulmonary hypertension who had been established on targeted drug therapy for between 3 and 12 months. The intervention included a detailed consultation assessing functional, social and motivational status to identify individual patient rehabilitation goals and facilitate tailored referrals to community-based services. Results One hundred and thirty-eight patients (79% pulmonary arterial hypertension, 17% chronic thromboembolic disease), age 67 ± 14 years, diagnosed over a one year period were evaluated between July 2017 and January 2018. Fifty-two per cent of patients were referred to community-based pulmonary rehabilitation programmes, 19% received other forms of community rehabilitation, 17% were given exercise advice, 5% had an assessment of social support and 7% declined any intervention. At the end of the study, 32% of patients were undertaking independent exercise. Conclusion This study has identified that the majority of patients with pulmonary hypertension who are optimised on targeted drug therapy have rehabilitation needs. The use of a physiotherapy well-being review can identify this need and facilitate access to community-based rehabilitation. Further research is required to evaluate the efficacy of such interventions in pulmonary hypertension.

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

“…17–20 Uptake of pulmonary rehabilitation is variable, 21 with low rates of independent exercise once the programme had finished. 22…”

“…[17][18][19][20] Uptake of pulmonary rehabilitation is variable, 21 with low rates of independent exercise once the programme had finished. 22 It is well-recognised that physicians' personal level of physical activity correlates with the likelihood of them encouraging exercise in their patients. 23,24 Although potentially influenced by recall bias, doctors self-reported being more active than the general population, with a greater proportion of doctors meeting recommended national guidelines for levels of physical activity (78% of survey participants compared to 64.5% of the general US population).…”

Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations

“…Scientific evidence supports the notion that rehabilitation is a beneficial and safe non-pharmacological approach that should be considered in clinical strategies for the treatment of PAH [ 22 , 38 ], providing strong evidence for ET as an effective method of significantly improving the patient’s clinical condition [ 30 ]. However, the optimal model for rehabilitation in PH has not yet been established and may differ depending on the country or setting [ 18 , 26 , 39 ]. Despite this, there is a growing general interest among clinicians in more accessible methods of improving the functional status of patients has prompted them to increasingly use ET as adjuvant therapy.…”

“…However, inpatient rehabilitation is not widely available in many countries and potentially excludes patients whose lifestyle doesn’t permit them to follow this approach [ 15 , 19 , 39 , 41 ]. It is also difficult to replicate the intensity of this exercise program in routine clinical practice due to limited resources and personnel [ 42 ].…”

Outcome Measures Used in Studies of Rehabilitation in Pulmonary Hypertension

“…While exercise rehabilitation was first shown to improve exercise capacity and quality of life in patients with PH in 2006 (2), greater understanding of the benefits of rehabilitation in patients with pulmonary hypertension is still required (3,4). Effective rehabilitation is a complex, multifaceted intervention with the potential to impact not just the underlying health condition, but also the daily life of patients, their independence and community connections (5).…”