Implementing Pulmonary Rehabilitation in Primary care: Feasibility, acceptability, and safety

The aim of this study is to investigate whether upskilling private practice physiotherapists and accredited exercise physiologists (AEP) to provide pulmonary rehabilitation (PR) in the primary care setting is feasible to implement, acceptable to stakeholders and effective in achieving the known beneficial outcomes of PR. The study consists of two parts. Part one: Clinician participants will be given access to the Lung Foundation Australia Pulmonary Rehabilitation Online Training Program. The program is a 6-8 hour online training program that aims to increase the knowledge and confidence of health professionals to deliver evidence-based PR. The course includes modules on: • Establishing a pulmonary rehabilitation program • The respiratory system and COPD • Comprehensive patient assessment • Patient assessment – Spirometry • Patient assessment – Assessing exercise capacity • Patient Assessment – Quality of life • Exercise training • Patient education • Program evaluation and troubleshooting The online training will be delivered online on a learning platform with interactive infographics, text and animation. Participants will complete the course at their own pace within the 3 weeks prior to their practical module. The program duration is approximately 6-8 hours. Completion of modules will be monitored by the learning platform analytics. After completion of the online training program, participants will attend a practical face-to-face module. Attendance will be monitored by session attendance logs. The practical module will be a group session, delivered by experts in pulmonary rehabilitation. It is estimated to that practical module will be a single 3-4 hour session. The maximum participants to facilitator ratio will be 3:1. The practical module will focus on practical aspects of content from the online program, including: • Performing exercise capacity tests • Exercise prescription Participants will be followed up 3-months after completing the training, prior to commencing Part Two of the study. Part two: Patient participants in the intervention group will undertake twice weekly PR at an allocated physiotherapy / exercise physiology practice for 8-weeks. After Visit 1 is completed, participants will be booked into the next available spot in the PR program. Private practice PR programs can be rolling or cohort programs with a minimum of 3 and a maximum of 8 participants in any one cohort. There should not be more than 2 weeks between Visit 1 and the commencement of the intervention. PR sessions will follow the Australian and New Zealand Pulmonary Rehabilitation guidelines and consist of at a minimum 30 minutes of lower limb endurance training, strength training and a home exercise program. Physiotherapists or AEPs delivering the intervention will prescribe each participant’s exercise program for each PR session in accordance with the current evidence-based practice guidelines. As per the training clinician participants were given in Part one of the study, participants will be prescribed lower limb endurance exercise intensity based on their baseline exercise capacity assessment. Intensity will be progressed throughout the intervention based on symptoms (measured by Borg dyspnoea scale). Upper and lower limb strength exercises will be prescribed from symptoms, measured by Borg scale. Exact exercises will be left to the physiotherapist or AEPs discretion and will consider existing exercise equipment at their practice, participant goals and past medical history. All intervention sessions must contain a walking exercise component, either treadmill walking or ground walking. Other examples of exercises may be stationary cycling, upper and lower limb strengthening exercises using resistance bands or free weights. Clinicians must document the mode, duration, intensity, type, and progression for each exercise prescribed. Frequency should be defined in the home exercise program. The home exercise program will be individualised and progressive. Home exercise programs will be performed at a minimum of once per week, the content of the home exercise program will be determined by the treating clinician. Session attendance logs and participant exercise logs will be used to monitor intervention fidelity.