Provision of a Home Exercise Programme as an alternative to Pulmonary Rehabilitation as part of an Integrated Respiratory Team

Purpose

Traditional Pulmonary Rehabilitation (PR) has been offered in Oxfordshire for the past 12 years. There has been no alternative for the 40% of referrals received annually where the patient is unable or unwilling to attend. The Integrated Respiratory Team was trialled with scope to offer something different to traditional PR. A supervised home exercise programme (HEP) could be a feasible alternative to PR to increase the numbers of patients with COPD able to self manage.

40%
of patients referred for traditional pulmonary rehabilitation are unable or unwilling to attend.
10/12
patients offered a HEP improved their exercise tolerance significantly

Approach

Patients were identified following hospital admission or by the community respiratory team as requiring PR but were either unable to attend due to mobility or transport reasons, or were unwilling to attend the groups. A physiotherapist triaged the patients for suitability to exercise, and the patient was then provided with a 6-session HEP by either the physiotherapist or the assistant respiratory practitioner consisting of similar exercises given within a traditional PR programme. Outcomes were exercise tolerance as measured by 5 repetition sit-to-stand (5RSTS) or 4 metre gait speed (4MGS), and the COPD Assessment Test (CAT). Patients were also offered a place on traditional PR following completion of their HEP.

Outcomes

Results: 39 referrals for a HEP were received. 4 declined input, 1 has not responded to attempts to contact, 3 were unsuitable for input. 15 had their input suspended as a result of COVID-19. Three patients stopped their HEP due to other health reasons after starting. Of the 12 patients who have completed the programme so far, 10 improved their exercise tolerance significantly and all patients improved their CAT score significantly. Five patients were enrolled onto PR following their HEP.

Conclusion(s): A formal supervised HEP can be a useful and effective alternative to traditional PR, with improvements seen in both exercise tolerance and health related quality of life measures for patients who have been difficult to engage in the past. The improvements seen may not be as great in those seen in our traditional PR, but are greater than those seen in control groups of previously published research.

Cost and savings

This was part of a larger pilot project, so accurate costs for this specific piece of work are difficult.

Implications

The large numbers of referrals received by the Oxfordshire Pulmonary Rehabilitation Service leads to a significant number of patients not receiving traditional PR for a variety of reasons. 40% of current referrals do not even get assessed. Being able to offer a home exercise programme will help to reduce the number of patients receiving no input, but also help to increase the likelihood of some patients attending traditional PR, which has its own well documented benefits beyond those offered by a home exercise programme.

Top three learning points

No further information. 

Funding acknowledgements

This was part of a larger Integrated Respiratory Team pilot project, with funding from Oxfordshire CCG and Boehringer Ingelheim.