[vc_row gap=”35″][vc_column][vc_column_text]Background to the development of home-based pulmonary rehabilitation
Pulmonary rehabilitation is a cornerstone of care for people with chronic obstructive pulmonary conditions and has traditionally been held in hospitals and community centres.
There is robust evidence that pulmonary rehabilitation improves exercise capacity, reduces symptoms, enhances health-related quality of life and reduces health care utilization but the uptake of traditional centre-based pulmonary rehabilitation programs is generally poor.
Home-based pulmonary rehabilitation is an alternative model that could improve uptake and access and has been shown to have equivalent outcomes to centre-based programs.
A home-based program may be suited to patients who:
- Do not live near a centre-based program
- Do not own a car or have difficulty with public transport
- Work full time and cannot take the time off work to attend a centre-based program
- Have young children at home
- Are caring for a frail partner at home
- Do not like working in groups
- Like the flexibility of being able to exercise when it suits them
It may not be suited to people who:
- Are medically unstable and require supervision whilst exercising
- Prefer to work in groups
The burden of frequent travel to a centre-based program, in the setting of distressing exertional dyspnoea and mobility limitation, is consistently cited by patients as a barrier to attendance.
Referrals to a home based pulmonary rehabilitation program are made in the same way as for a centre based program. A letter, written by the patients GP, respiratory specialist or physiotherapist, including medical history and current exercise tolerance is sent to the pulmonary rehabilitation co-ordinator.
After the initial assessment the patient may be able to choose to attend group sessions at the medical centre or to exercise at home with the guidance of weekly telephone calls from a physiotherapist. This choice will not be available to patients who require medical supervision whilst exercising or if a home based program is not yet available.
For more information on pulmonary rehabilitation programs, go to the Pulmonary Rehabilitation Toolkit
Comparing home based and centre based programs
|Home based||Centre based|
|Patients attend a hospital or community centre for an initial assessment||Patients attend a hospital or community centre for an initial assessment|
|Physiotherapist attends the patients’ home to set up an exercise program – patient can make a suitable appointment time||Patient attends first day of a pulmonary rehabilitation program in a medical centre – no choice of day or time|
|Patient exercises at home or in their local environment|
at times that suit their daily routine for 6 to 8 weeks
|Patient attends the medical centre on set days at set times for 6 to 8 weeks and joins in a group exercise session|
|The patient monitors their condition by themselves during their exercise using the two Borg scales – perceived Shortness of Breath and Perceived Exertion. The patient may choose to purchase a pulse oximeter and blood pressure monitor for use at home|
They may also learn to monitor their heart rate
|The patient is monitored by both themselves and the medical staff using heart rate, oxygen saturation and blood pressure readings as well as the two Borg scales - perceived Shortness of Breath and Perceived Exertion|
|A physiotherapist rings the patient at a mutually agreed time each week of the program to discuss their progress, their goals and their issues||The physiotherapist discusses the patients’ progress, goals and issues during the group session|
|The education sessions are designed around the patients’ needs||If available, the patient attends the education sessions at the medical centre at the end of each exercise session|
|Patients attend a hospital or community centre for the follow up assessment||Patients attend a hospital or community centre for the follow up assessment|
|Referrals are made either during or at the completion of the program to other health professionals as prescribed by the physiotherapist||Referrals are made either during or at the completion of the program to other health professionals as prescribed by the physiotherapist|
|Patient is offered a maintenance program to continue at home or is referred to a group maintenance program if requested by the patient||Patient is offered a maintenance program to continue at home or is referred to a group maintenance program if requested by the patient|