Abstract
Introduction/Background summary: Pulmonary Rehabilitation (PR) is an important element in the long-term management of chronic respiratory disease, focused on program participation & outcomes results. National Clinical Programme (NCP) guidelines state that PR pre-assessments must include a measure of quality of life (QoL) and a psychological measure (NCP Respiratory 2020).
Who is it for? The patient cohort included individuals aged >18 years old, with a confirmed diagnosis of COPD and/or Asthma.
Who did you involve and engage with? Members of the MDT included respiratory nurses, respiratory physiotherapists, local GPs and a respiratory consultant.
What did you do? In the Mayo Hub, the pilot PR programme was run in Swinford with a group of N=9. Measurements of anxiety, depression and QoL were completed at baseline, following the 8-week programme and at three months follow up. Outcome measures included the Eq-5d-5l and HADs.
What results did you get? Despite improvements in reported anxiety, depression and quality of life scores following the eight week PR programme, these improvements were not maintained at the three month follow up, with some regressing beyond their baseline scores. Of the cohort of patients, 66% reported an improvement in self-reported anxiety scores. However, 50% of those that improved, regressed at the 3 months follow up. QoL was reduced at the 3 month follow up in 44% of patients compared to the post assessment. Of concern, 55% of patients demonstrated an increase beyond their baseline depression scores at the 3 months follow up.
What is the learning? This study indicates that despite achieving improvement in anxiety, depression and QoL in line with current research (NCP Respiratory 2020; BTS Guidelines 2013), these benefits were not maintained at 3 months follow up.
What are the next steps? Further research is required to confirm these findings. Within the Mayo Hub, data will continue to be collected and analysed. This study supports the option of a maintenance programme in the community to retain the improvements in quality of life and psychological outcomes achieved in the initial PR programme. Also, this study indicates that appropriate psychological services in the community are required to support those identified in the programme as eligible for psychological input.
References:
HSE National Clinical Programme Respiratory 2020. A guidance document for setting up a Pulmonary Rehabilitation Programme for Healthcare Professionals. Available from: https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/copd/resources/hse-guidance-document-on-pulmonary-rehabilitation.pdf (accessed 10 November 2023)
The British Thoracic Society Pulmonary Rehabilitation Guideline Development Group. BTS Guideline on Pulmonary Rehabilitation in Adults. Thorax 2013; 68:Suppl 2.