Pulmonary Rehabilitation and Knowledge Translation into Care and Life

Exacerbations of Chronic Obstructive Pulmonary Disease, particularly when resulting in hospitalization represent important events on both an individual and population level. In the stable state Pulmonary Rehabilitation has been shown to be one of the most efficacious treatments and is firmly established as a central therapy in standard practice. Over the past ten years, post-exacerbation Outpatient Pulmonary Rehabilitation has developed and the crucial role it plays is reflected within a recent Cochrane review by Puhan et al. (2011) followed by a later published Randomised Control Trial by Ko et al. (2011), stating that Pulmonary Rehabilitation delivered within three weeks of COPD exacerbations significantly reduces short term risk of future hospital admissions, improves health related quality of life and short term exercise capacity measured by the Six Minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT). All results were of statistical significance. Furthermore it is important to note that there were no adverse events or excess mortality seen in post-exacerbation Pulmonary Rehabilitation compared with usual care. Non-surprisingly international guidance (BTS 2013, Spruit et al 2013) recommends that Pulmonary Rehabilitation be offered to patients at discharge following an exacerbation of COPD to commence within one month.

One of the most consistent findings from clinical and 
health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare while healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Unfortunately we are unable to evaluate how well post exacerbation Pulmonary Rehabilitation is being implemented in line with internationally recognized guidelines on a local level, however evidence suggests that despite such benefits only 31% of eligible patients are indeed referred and for those that do attend it has been appreciated that this comprises the minority of the COPD population, with a 90% non-completion rate highlighted within a clinical audit over a 12 month period, the only study to date to examine referral, uptake and adherence amongst COPD patients post exacerbation.

To my knowledge there have been no similar existing projects undertaken using a method of co-production to facilitate the implementation of international guidance into practice for post-exacerbation Pulmonary Rehabilitation. I envisage that my project will contribute to addressing the knowledge gap that exists when exploring solutions to facilitate referral and uptake, thus providing a foundation from which others can base their research or indeed apply the findings to enhance the delivery of their own services locally. Furthermore given that there are many mining villages surrounding Doncaster Royal Infirmary and Montagu Hospital and how this may influence socio-economic status one may suggest that the information gleamed will be of value to other localities with similar patient populations since these patients are likely to be influenced by similar barriers to uptake (Cox et al. 2017).

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