Pulmonary rehabilitation can be conducted in a variety of settings, including hospital outpatient departments, the community, and within the home.
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, and access to acute medical care if required. 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 supplemental oxygen.
Inpatient pulmonary rehabilitation is sometimes provided for patients recovering from an acute exacerbation.
Pulmonary rehabilitation (either inpatient or outpatient) following an exacerbation of COPD improves health-related quality of life and exercise capacity, and reduces hospital readmissions, and has been shown to be safe with no adverse events.23
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). Community-based exercise training should be prescribed at a similar frequency and intensity as hospital-based programs in order to achieve clinically meaningful benefits for patients.
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. Home-based pulmonary rehabilitation is recommended in the Aust/NZ pulmonary rehabilitation guidelines1 as an effective alternative to centre-based programs. A variety of home-based models are available, ranging from home visits for direct supervision to weekly telephone calls.24 Regardless of the model, regular contact is essential to ensure that the exercise training program is progressed throughout the program.
Home programs may be beneficial for those patients who are unable to attend a centre-based program (eg due to isolation, transport difficulties or symptoms). However, potential limitations of home-based programs are that the patient lacks the peer support gained from exercising in a group setting and that exercise progression is not directly supervised. There are no guidelines regarding which patients are most suitable for home-based programs and patient preference is an important consideration.
Lung Foundation has developed a resource that may complement exercise component of home program: Better Living with Exercise – Your Personal Guide. Please note, this is designed to be only used by a Physiotherapist or an Accredited Exercise Physiologist