To implement and evaluate an alternative method to traditional pulmonary rehabilitation (PR) for delivering exercise and education interventions to individuals with Chronic Obstructive Pulmonary Disease (COPD) in Oxfordshire.
Patients at a specific GP practice in a low socio-economic area of the county were identified following declining standard PR either at the point of referral or after the offer of an appointment. They were then invited to our better breathing group, which was run in the GP practice The group consisted of 4 weekly hour long sessions where a self-management plan was completed with the patient and pertinent education sessions were delivered. Up to 4 patients were invited to each group and the sessions were run by at least 1 physiotherapist and 1 assistant, with input from a pharmacist, occupational therapist and nurse for the appropriate sessions. education topics included managing breathlessness, spotting and managing flare ups and completion of a self- management programme, medication review and technique check, pacing strategies and airway clearance. Other topics were discussed on an ad-hoc basis at the request of patients. Exercise was discussed only at the request of patients, though was a common theme. Any changes in health status were monitored using a 5-repetition sit to stand test (5RSTS) and the COPD Assessment Test (CAT).
Results: A total of 5 patients completed the course over 2 months. Each patient reported that the course has helped them to feel better about managing their COPD, and that they were reassured by the support available to them which they hadn’t necessarily realised previously. 2 patients improved their CAT score significantly, and all improved their 5RSTS significantly. 2 patients asked for a referral to traditional PR following completion of the course.
Conclusion(s): The Better Breathing group was well received by patients and GP’s alike, though only a small number of patients attended or completed the course. It is surprising that exercise tolerance improved as it did, as we did not put any emphasis on exercise interventions, and hypothesise this may be due to improved confidence managing their condition. Further investigation is needed to establish whether it is a feasible alternative to traditional pulmonary rehabilitation., though the early signs are promising.
Cost and savings
As this was part of a larger project, costs are difficult to determine.
Further work is needed, but this could be valuable a way to help engage patients who have not previously engaged in traditional PR or community respiratory services in a way that is not frightening and in a way that encourages self-management, ultimately aiming to reduce the strain on primary care and acute services.
Top three learning points
No further information.
Funding for this project came as part of the Integrated Respiratory Team pilot project, aiming to enhance the care of COPD patients across Oxfordshire. The funding for the project was from Oxfordshire CCG and Boehringer Ingleheim.