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Position statement and considerations for remotely delivered pulmonary rehabilitation services

Lucy Gardiner University of Leicester, Leicester, U.K. and University of Birmingham, Birmingham, U.K. , Anna Alderslade NENC Respiratory Clinical Network, NHS England. , Frances Butler York and Scarborough Teaching Hospitals NHS Foundation Trust, York, U.K , Emma Chaplin University of Hospitals of Leicester NHS Trust, Leicester, U.K. , Rachael Colclough University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K. , Jane Douglas Hywel Dda University Health Board, U.K. , Siobhan Hollier BOC Healthcare. , Jack Plumbe RespiriCare , Laura Graham Homerton Healthcare NHS Foundation Trust, U.K. , Claire Nolan Brunel University London and Guy’s and St Thomas’ NHS Foundation Trust, U.K. , Kelly Wainwright Solent NHS Trust, Southampton, U.K. , Agnieszka Lewko Coventry University


Lucy GardinerUniversity of Leicester, Leicester, U.K. and University of Birmingham, Birmingham, U.K,,

  • Abstract
  • Full text
  • References
  • Appendices

Statement and methods of development

The challenge of access to pulmonary rehabilitation (PR) and meeting associated service demand is certainly not new. However, the COVID-19 pandemic set an unprecedented challenge evoking rapid adaptation of services. An inherent spotlight has been placed on remotely delivered services. As we look beyond the height of this pandemic, it is important to reflect and consider what has been learnt, and emerging perspectives on the future of PR service delivery.

This document updates the ‘ACPRC statement and considerations for the remote delivery of pulmonary rehabilitation services during the COVID-19 pandemic’ (1) and seeks to provide pragmatic practical guidance for remotely delivered models of PR for healthcare professionals that should be used alongside local guidance. The recommendations provided are for guidance only, and may be updated in response to further national guidelines and new evidence.

An online survey of PR healthcare professionals (ACPRC pulmonary rehabilitation provision during COVID-19 and beyond!) was conducted in the development of this document to scope current practice in PR services across the U.K. Informed by queries received by the ACPRC, the survey was first conducted in 2020 and repeated in July 2021 with the aim of capturing a snapshot of practice, one-year post onset of the COVID-19 pandemic. The survey was publicised and disseminated via Twitter using the @theACPRC handle, with request that one team member completed on behalf of their service. A summary of the 21 responses can be found in Appendix 1 which served to inform the content of this document.

A literature review was undertaken to identify and integrate relevant published trials since the 2021 Cochrane review of telerehabilitation for people with chronic respiratory disease (2). Details of the search strategy can be found in Appendix 2 and summary of study characteristics and outcomes in Appendix 3.

Anonymous feedback from four PR services was collated and analysed to identify common themes in experiences of remotely delivered PR services. A summary of this process and collated feedback can be found in Appendix 4.

Key terms

  • Remotely delivered models – the delivery of pulmonary rehabilitation services at a distance; the interaction between healthcare professional and participant using communication and information technologies, that may take place in real-time (synchronously) or asynchronously (1). It may be delivered by a virtual platform, an online web application or programme, or referred to as telerehabilitation (note: this terminology is used where studies have reported it).
  • Field walking tests are commonly employed to evaluate exercise capacity, prescribe exercise, and evaluate treatment response in chronic respiratory diseases (3). The most valid, reliable and responsive ones are the six-minute walk test (6MWT), incremental (ISWT) and endurance walk test (ESWT).
  • NACAP – the National Asthma and COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP), as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and currently covers England and Wales. The programme is led by the Royal College of Physicians (RCP) and includes a pulmonary rehabilitation workstream.
  • PRSAS – the Pulmonary Rehabilitation Services Accreditation Scheme was launched in April 2018, and is run by the Royal College of Physicians (RCP).

2023 Journal (Vol. 55 Issue1)
Journal of the Association of Chartered Physiotherapists in Respiratory Care. Volume 55. Issue 1. 2023. Article on: p64-112
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