To Pulmonary Rehab and Beyond! Can we make it last?

Jean DriscollPhysiotherapistPulmonary RehabilitationDundeeMay 2011

• COPD is only major chronic disease with increasing mortality

• PR now considered an essential component of the integrated care of patients with copd

• Benefits include-reduced dyspnoea, increased exercise performance, improved HRQOL, reduced health care costs

• Immediate goals of PR are indisputable but maintaining these benefits and seeing them translate into health advantages remains elusive

• We must keep our patients motivated and committed to their long-term health

Dundee PR programme

• 3 classes per week• 12 patients per class• 6 week duration• 252 pts per year• 78% completion rate• 194 pts eligible for maintenance

Dundee maintenance programme• Funded• 3 local leisure centres• Fitness coaches• No review with PR staff

Maintenance Survey

• Aims of Study• To find out the percentage of people

going on to maintenance after pulmonary rehab

• To find the reasons why people drop out of maintenance

• Is there a better way to run the maintenance programme?

Methods

100 patients were followed up after they had completed a six week pulmonary rehabilitation programme. Of these 90 were successfully contacted at the designated times. This was in the form of a telephone call at one month, three months and six months post rehab. Permission was sought at each phone call.

Aims

To determine if patients had;• attended maintenance immediately

post rehabilitation• were still attending maintenance• never attended maintenance and

reasons why not• stopped attending maintenance and

why

Results

• At the end of the six week course all patients were asked to go on to maintenance but only 72 said they would. Reasons for this included no transport, not well enough and not wanting to go to a public gym. (See figure 2)

At one month it turned out that in fact only 37 people were attending maintenance.

This attendance figure then dropped to 25 people at three months and to only 21 people attending at the six months phone call

Discussion

• This study sought to find out the number of people going on to maintenance after Pulmonary Rehabilitation. It also looked at the reasons why people dropped out of the maintenance classes.

• Disappointingly it proved that only 23% of patients finishing rehab continued to attend at six months. The main reasons for dropping out would appear to be lack of motivation and not enjoying the maintenance classes.

• In view of the cost of running the maintenance classes with the ever increasing burden of COPD, together with the compelling evidence of the benefits of pulmonary rehab and maintenance it would make sense to look into a different model of post pulmonary rehab aftercare in Dundee

How do we get patients to attend maintenance?• 100% of pts completing class want to be

reviewed by PR staff• Recent evidence suggesting increased

uptake of maintenance if classes ran by rehab staff (joanne cockram et al)

• Discuss importance of maintenance in more depth highlighting benefits, (maarten j fischer et al resp med 2009)

Dundee proposal

• extra class ‘drop in style’• Led by PR staff• Community based• Pts will pay for hall• Circuit based class• Review of pts at 3, 6 and 12 month

intervals from all classes

Aim of project

• The primary aim is to establish whether a supervised maintenance class led by PR staff will increase the numbers of pts continuing on into maintenance classes

• It is hoped that the fact the pts will be reviewed will increase the motivation to maintain

Audit

• Once extra class established then take 100 pts as before and check uptake of all maintenance in Dundee