Location of Training Program
Pulmonary rehabilitation can be conducted in a variety of settings, including hospital outpatient departments, the community and within the home. Most of the evidence for pulmonary rehabilitation has been gathered from centre-based programs.
Hospital-based programs are predominantly outpatient programs provided on a hospital campus, using hospital-based staff and equipment. This environment has the advantage of providing direct communication with respiratory physicians and other healthcare professionals. Hospital-based programs may be the most appropriate option for patients with very severe disease and/or complex comorbid conditions. Other indications for hospital-based programs include the requirement for high levels of supplementary oxygen and to enable direct access to the healthcare team for individuals at risk of complications in the early period following thoracic surgery. Further, patients who desaturate below an oxygen level of 88% during exercise training, despite the use of interval training, should be assessed in a hospital-based program to determine the benefits of supplementary oxygen.
Some hospitals may provide supervised home-based rehabilitation for patients who have recently been discharged or patients being treated at home for an acute exacerbation. In these instances, hospital-based staff provide the home-based service.
Inpatient pulmonary rehabilitation is sometimes provided for patients recovering from an acute exacerbation. There is evidence that exercise training following an acute exacerbation of COPD is effective (See Puhan 2009).
Community-based programs are centre-based programs run in community settings (eg leisure centres; halls, health or rehabilitation centres; senior citizens centres or private practices). These programs may be run by hospital/community health staff, or may use clinicians in community practices (eg GPs, practice nurses, private practice clinicians).
Home-based programs are conducted in the patient’s home, usually with some form of follow up contact, for example via face to face visits or telephone calls. Exercise videos may also be provided. These programs may be beneficial for those patients who are unable to manage attending a centre-based program (eg due to isolation, transport difficulties) and for those with severe deconditioning following an inpatient admission. However, potential limitations of home-based programs are that the patient lacks the peer support gained from exercising in a group setting and progression of exercise is more difficult when exercise is not supervised.