Increasing access to pulmonary rehabilitation through utilising primary care

Abstract

Background: Pulmonary rehabilitation (PR) improves exercise capacity and health-related quality of life (HRQoL) for people with chronic respiratory disease (CRD), yet only 5-10% of eligible patients access a program. PR is predominantly delivered in hospital outpatient settings, with accessibility a key barrier. Most physiotherapists and accredited exercise physiologists (AEPs) work in private practice (PP), an untapped workforce that could deliver PR in primary care, but no funding model currently supports this. This thesis investigated whether upskilling PP physiotherapists and AEPs to deliver PR in primary care is feasible, acceptable and effective.

Methods: A two-phase mixed-methods feasibility study comprised: a prospective cohort study of a PR training program for PP clinicians; a randomised controlled feasibility trial comparing an 8-week twice-weekly PR program in PP to usual care for people with COPD and interstitial lung disease; and a qualitative study of patient experiences and acceptability. In addition, a national cross-sectional survey of PP clinician interest and resources was conducted.

Results: Training improved clinician knowledge, with 82% achieving the competency threshold post-training compared to 13% pre-training. The feasibility trial randomised 52 participants; 72% completed the intervention. Within-group changes in exercise capacity and HRQoL exceeded minimally important differences, with only one minor adverse event. Qualitative analysis identified high acceptability and a shift away from a passive illness-identity. The survey received 245 eligible responses; 91% of clinicians were interested in delivering PR and most practices had suitable resources, though current funding limited business sustainability.

Conclusion: PP physiotherapists and AEPs upskilled in PR can feasibly deliver PR programs with promising clinical outcomes. A full-scale trial with longer-term follow-up is warranted to support advocacy for a funding model.