The past, present and future of pulmonary rehabilitation

Abstract

Abundant evidence supports the use of pulmonary rehabilitation as a treatment for stable and exacerbated chronic obstructive pulmonary disease. Several questions around the science base of rehabilitation in other patient groups as well as the role of rehabilitation as a component in other comprehensive care trajectories remain to be addressed. The impact of a rehabilitation programme could also perhaps be enhanced if clear guidance would be available on how to individualize the components of a rehabilitation programme in individual patients. The rehabilitation community, in an attempt to increase access to programmes, has developed less rigorous interventions. These may serve specific patients (e.g. less severe patients or may be used as a maintenance programme), but in order to have conceptual clarity they should not be called substitutes for rehabilitation if they do not meet the definition of rehabilitation. Reaching clarity on the best format for maintenance programmes in order to achieve long-lasting health benefits for patients is another challenge. Furthermore, as many patients as possible should be referred to adequate rehabilitation programmes within their reach with fair reimbursement. Programmes should take into account the burden of the disease of a patient, the required components to tackle the problems, adequate assessment to document the outcome and the patient's preference. In summary, pulmonary rehabilitation is one of the most potent evidence-based therapies for patients with respiratory diseases. Researchers should continue to fine tune the interventions, get clarity on terminology as well as the ultimate outcomes for rehabilitation to ensure sustainable health effects.

Respiratory rehabilitation for post-COVID19 patients in spa centers: first steps from theory to practice

“…During the entire program, patients are assisted by dedicated physiotherapists with expertise in respiratory rehabilitation and they can also benefit from medical checks provided by spa physicians. Consultations with specialized medical doctors and general practitioners, along with adherence to general evidence-based rehabilitative recommendations, can further improve the quality of care thanks to an optimal integration of multi-disciplinary skills and knowledge (Clini et al 2018 ; Troosters et al 2019 ).…”

Optimizing health in chronic lung diseases: What did we learn from the experts in pulmonary rehabilitation?

“…Choice of setting may aid compliance with rehabilitation; however, some review authors expressed concern that some settings (e.g. home‐based rehabilitation) may lead to variations in the amount of individual tailoring possible and may reduce the ability to address the specific needs of some patients . This has led to controversies over what can be termed ‘pulmonary rehabilitation’.…”

“…The review by Spruit and Wouters highlights the complex conditions that can be addressed in a sophisticated PR programme and provides food for thought about the unanswered questions relating to the potential limitations of home programmes. Troosters et al . point to areas of future research needed to develop a ‘blueprint’ PR programme, such as determining the optimal programme duration, essential components, setting and type of patients who would benefit the most .…”

“…Troosters et al . point to areas of future research needed to develop a ‘blueprint’ PR programme, such as determining the optimal programme duration, essential components, setting and type of patients who would benefit the most . Web‐based rehabilitation programmes are now available, and rigorous evaluation will be required to determine their place in the rehabilitation continuum.…”

Chronic respiratory diseases: The dawn of precision rehabilitation

“…The need for individualized assessment and management permeates this series and makes a great deal of sense. Troosters et al . remind us that exclusive focus on enhanced cardiorespiratory fitness as the traditional outcome measure of interest for PR may be a little short‐sighted.…”