The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

THE EXTENT OF PULMONARY REHABILITATION PROGRAM MODIFICATIONS TO ACCOMMODATE PATIENTS WITH RESTRICTIVE LUNG DISEASE

Kimberly A. Garfield1, Brittannie L. Hall1, Carrie L. Netcher1,Phillip D. Hoberty1



Background: Pulmonary rehabilitation (PR) has proven beneficial for patients with chronic obstructive pulmonary disease (COPD) and may benefit patients with restrictive lung disease (RLD). We studied the extent to which PR programs have been modified to meet the needs of patients with RLD. Also, if the patient outcomes were related to the extent of modifications.

Methods: This descriptive research was accomplished by written questionnaire that was land-mailed to a random sample of one third of the program directors listed in the Program Directory of the AACVPR. Follow up of non-respondents was accomplished by e-mail letters with the questionnaire as an attachment. Descriptive and Crosstabs procedures were used to look for correlations with calculation of Pierson X2 and other statistics of nominal correlations.

Results: We received 59 usable responses of the 151 sent for a return rate of 41%. Community hospital programs represented 53%, while 46% came from health science centers and larger medical centers. No program exclusively designed for the patient with RLD was reported. Sixty one percent had made modifications to their programs. The most common modifications were: exercise, use of supplemental oxygen, breathing retraining and psychosocial intervention. Exercise sessions were shorter and less intense than those for COPD patients, with higher oxygen liter flows used earlier in exercise sessions accompanied by more close monitoring of oxygen saturations. Managers were divided as to putting more or less emphasis on breathing retraining techniques. The RLD patient got more psychosocial interventions and was more likely referred to professional help. There was no single modification that was related to the level of outcome in any of the four domains. Ninety percent of managers felt RLD patients achieved positive outcomes as well or better than did those with COPD in behavioral and service/satisfaction outcomes. But, 32% of managers felt RLD patients were worse in clinical and health status outcomes. There was no relationship between the number of modifications and outcomes.

Conclusion: Most managers have made modifications in their PR programs to accommodate patients with RLD. There were no programs exclusively for such patients. There is a pattern to current modifications. A greater number of modifications did not result in better outcomes. Further research with objective, quantifiable outcome measures should be completed.