Home-Based Pulmonary Rehabilitation Pilot – A response to the COVID-19 pandemic

Nicola Smart1, Michelle McMahon1
Bass Coast Health

ABSTRACT

Background or Problem/ Issue:

Lung disease contributes to 7.5% of the overall health burden in Australia (AIWH,2019).  Pulmonary rehabilitation can help improve quality of life and exercise capacity and reduce symptoms and hospitalisation rates (Lung Foundation, 2017).  During the COVID-19 pandemic, centre-based group exercise and education programs at Bass Coast Health were suspended due to the risk of community virus transmission.  A safe and effective alternative rehabilitation program was required for a high-risk respiratory population.  Home-based pulmonary rehabilitation programmes have been found to deliver potentially equivalent benefits to traditional centre-based pulmonary rehabilitation (Lung Foundation, 2017).  Therefore, a prospective Home-based interventional Pulmonary Rehabilitation pilot was developed, aiming to improve exercise capacity, shortness of breath, fatigue and quality of life in parity with our centre-based program.  This was particularly pertinent in the rural setting due to barriers accessing health services.

Method or What you did?

An evidence-based Clinical Guideline was developed with clear inclusion and exclusion criteria.   Waitlisted patients residing in Bass Coast were screened for eligibility by respiratory nurses.  Patients were enrolled in a six-week exercise and an eight-week education component.  A physiotherapist completed an initial Home Visit to assess patient’s health background and safety to exercise.  The one-minute sit-stand test was used to measure exercise capacity, and perceived exertion, pulse rate and SpO2 were recorded.  Each patient received a tailored exercise program and education booklet.  Patients were called weekly to discuss the program, their exercises and any issues.  At the program completion, each patient was reassessed in the home and a survey was completed.  All patient contact adhered to organisational COVID-19 infection control procedure.

Results or Outcomes:

Differences in measures from baseline to program completion was analysed using descriptive statistics. Five participants completed the program in the analysis timeframe (one female, four males, aged 64-74).  The mean increase in exercise capacity was 18.9% (+2.6 sit-stands).  Breathlessness and fatigue were inconsistently reported.  Participants responded positively and reported improved quality of life.

Conclusions or Practice Implications:

This pilot program addressed exercise capacity, breathlessness and quality of life.  Early indicators are positive, however due to the small sample size and lack of available data for comparison to the centre-based program, more data is required to fully understand the program’s efficacy.  The program establishes an alternative delivery mode from centre-based program which may help reduce wait times and improve patient outcomes. Principles may be useful for other hospitals to implement in their own organisation.

References

  1. AIHW (Australian Institute of Health and Welfare). (2019). Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015. https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true.
  2. Australia and New Zealand Lung Foundation. (2017). Pulmonary Rehabilitation Clinical Practice Guidelines. https://lungfoundation.com.au/wp-content/uploads/2018/09/Book-Australia-and-New-Zealand-Pulmonary-Rehabilitation-Guidelines-Feb2017.pdf

BIOGRAPHY

I am a Grade 1 Physiotherapist (Doctor of Physiotherapy, University of Melbourne) who worked at Bass Coast Health (2019-2020).  My passion is rural health, addressing the health gap between urban and rural settings and connecting with the community.  I enjoy working in a supportive, team environment.

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