Improving access to and uptake of early pulmonary rehabilitation following hospitalisation for acute exacerbations of COPD
File(s)
Author(s)
Barker, Ruth Emily
Type
Thesis
Abstract
Background: Substantial benefits are associated with early pulmonary rehabilitation (PR) following severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring hospitalisation. However, referral for, and uptake of, early PR are poor.
Methods and findings: In a prospective cohort study of 291 hospitalisations for AECOPD, COPD discharge bundles delivered by PR practitioners were associated with increased PR referral (60% vs 12%, p<0.001; adjusted odds ratio [OR]: 14.46, 95% confidence interval [CI]: 5.28 to 39.57) and uptake (40% vs 32%, p=0.001; adjusted OR: 8.60, 95% CI: 2.51 to 29.50) compared with non-PR practitioners.
In a randomised controlled trial with convergent qualitative interviews, a co-designed education video delivered at hospital discharge did not improve post-hospitalisation PR uptake (41% usual care vs. 34% intervention group; p=0.37), referral, or completion. Six of fifteen interviewed participants from the intervention group did not recall receiving the video.
Given the poor uptake of outpatient post-hospitalisation PR, a mixed methods systematic review was conducted to explore the feasibility, acceptability and clinical effectiveness of home-based models of PR in the post-AECOPD setting. Although home-based exercise training appeared to be feasible and acceptable to patients and healthcare professionals (HCPs), there were few trials and data was heterogenous regarding clinical effectiveness.
A model of care integrating home-based exercise training and hospital at home care was co-designed by service users and HCPs. This was tested in a mixed methods feasibility study. The model of care was feasible and acceptable to patients, family carers and HCPs, and was not associated with adverse events, suggesting formal evaluation of clinical efficacy is warranted.
Conclusions: Both referrer and patient factors contribute to poor referral and uptake rates for post-hospitalisation outpatient PR. Home-based PR is feasible and acceptable to patients, carers and HCPs; further research is needed to explore clinical efficacy and cost-effectiveness of post-hospitalisation home-based PR.
Methods and findings: In a prospective cohort study of 291 hospitalisations for AECOPD, COPD discharge bundles delivered by PR practitioners were associated with increased PR referral (60% vs 12%, p<0.001; adjusted odds ratio [OR]: 14.46, 95% confidence interval [CI]: 5.28 to 39.57) and uptake (40% vs 32%, p=0.001; adjusted OR: 8.60, 95% CI: 2.51 to 29.50) compared with non-PR practitioners.
In a randomised controlled trial with convergent qualitative interviews, a co-designed education video delivered at hospital discharge did not improve post-hospitalisation PR uptake (41% usual care vs. 34% intervention group; p=0.37), referral, or completion. Six of fifteen interviewed participants from the intervention group did not recall receiving the video.
Given the poor uptake of outpatient post-hospitalisation PR, a mixed methods systematic review was conducted to explore the feasibility, acceptability and clinical effectiveness of home-based models of PR in the post-AECOPD setting. Although home-based exercise training appeared to be feasible and acceptable to patients and healthcare professionals (HCPs), there were few trials and data was heterogenous regarding clinical effectiveness.
A model of care integrating home-based exercise training and hospital at home care was co-designed by service users and HCPs. This was tested in a mixed methods feasibility study. The model of care was feasible and acceptable to patients, family carers and HCPs, and was not associated with adverse events, suggesting formal evaluation of clinical efficacy is warranted.
Conclusions: Both referrer and patient factors contribute to poor referral and uptake rates for post-hospitalisation outpatient PR. Home-based PR is feasible and acceptable to patients, carers and HCPs; further research is needed to explore clinical efficacy and cost-effectiveness of post-hospitalisation home-based PR.
Version
Open Access
Date Issued
2021-06
Date Awarded
2021-12
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Man, William
Wedzicha, Jadwiga
Sponsor
National Institute for Health Research (Great Britain)
Grant Number
ICA-CDRF-2017-03-018
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)