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British Thoracic Society Clinical Statement on pulmonary rehabilitation
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Journal Article
British Thoracic Society Clinical Statement on pulmonary rehabilitation
2023
Overview
Correspondence to Dr William Man; W.Man@rbht.nhs.uk Introduction The evidence-based British Thoracic Society (BTS) Guideline for pulmonary rehabilitation (PR) in adults was published in 2013.1 There is a strong evidence base for the benefits of PR,2 and it is one of the most cost-effective interventions for adults with chronic obstructive pulmonary disease (COPD).3 Furthermore, PR improves exercise capacity and health-related quality of life (HRQOL) in COPD to a much greater magnitude than observed with bronchodilator therapy.4 Since the Guideline, there is deeper understanding of referral characteristics, outcome measures, patient selection, programme delivery, potential adjuncts and the role of maintenance following PR. The BTS Clinical Statement on PR is a narrative review which provides a snapshot of current knowledge and best practice in topical areas by providing a series of clinical practice points that are informed by evidence where this exists, or based on expert opinion and collective clinical experience where evidence is limited. Measurement of core outcomes before and after PR. These should include a validated exercise test, measures of breathlessness and health-related quality of life, and other outcomes that evaluate core components of the intervention, such as lower limb muscle strength and disease knowledge. PR providers should work closely with relevant national professional societies and other stakeholders to develop competency documents and training programmes to maintain, upskill and expand the skilled workforce needed to deliver increased PR. Assessment and outcomes A high-quality PR assessment should include a multisystem approach that helps identify individuals who might benefit from other cost-effective interventions (such as vaccination and smoking cessation) or onward referral to multidisciplinary specialists. Assessment of patient safety for exercise training and exercise capacity to facilitate exercise prescription should be conducted in-person using a validated field walking test (incremental shuttle walk (ISWT), 6 min walk tests (6MWT)) or laboratory cardiopulmonary exercise test.
Publisher
BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
Subject
