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Chron Respir Dis. 2016 Aug;13(3):229-39. doi: 10.1177/1479972316642363. Epub 2016 Apr 12.

Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure.

Author information

1
NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK Harefield Pulmonary Rehabilitation Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, UK w.man@rbht.nhs.uk.
2
NIHR CLAHRC Northwest London, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
3
University of Exeter Medical School, Exeter, Devon, UK.
4
Centre of Exercise & Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom of Great Britain.
5
Department of Health Sciences, University of York, Heslington, York, UK.
6
Department of Palliative Care and Cambridge University, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
7
NHS West London Clinical Commissioning Group, London, UK.
8
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, UK.

Abstract

The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the 'most important' component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers.

KEYWORDS:

Breathlessness; COPD; consensus; heart failure; rehabilitation

PMID:
27072018
PMCID:
PMC5029782
DOI:
10.1177/1479972316642363
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Rod S Taylor is a co-author on a number of Cochrane reviews on cardiac rehabilitation and is the chief investigator on an ongoing National Institute of Health Research Programme Grants for Applied Research (RP-PG-1210-12004): Rehabilitation Enablement in Chronic Heart Failure (REACH-HF).

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