Pulmonary Rehabilitation Education Research Articles

The effect of a hybrid structured pulmonary rehabilitation education program for patients with lung cancer with a high risk of postoperative pulmonary complications: A quasi-experimental study

PurposeThe absence of standardized protocols and education are the main obstacles to perioperative pulmonary rehabilitation (PR), especially for patients with high-risk factors of postoperative pulmonary complications (PPCs). We aimed to explore the effect of a hybrid structured pulmonary rehabilitation education program (SPREP) on patients with lung cancer at high risk of PPCs. MethodsA quasi-experimental trial with a pre-post test design was conducted. The control group (n = 53) adopted routine perioperative pulmonary rehabilitation, while the intervention group (n = 53) received SPREP. Respiratory function, 6-min walk distance, Borg dyspnea scale, quality of life, anxiety–depression scores at admission, discharge, 2 weeks and 3 months post-discharge, and incidence of PPCs were compared between the two groups. ResultsThere were no significant differences on the 6-min walk distance and Borg Dyspnoea Scale at discharge between the two groups (P > 0.05), whereas the intervention group showed improved performance at the remaining time points (P < 0.05). In addition, the intervention group had improved exercise capacity, pulmonary function and quality of life, reduced levels of anxiety and depression at discharge, 2 weeks post-discharge and 3 months post-discharge (P < 0.05). In addition, incidence of PPCs was significantly reduced in the intervention group, especially postoperative pneumonia. ConclusionsThe SPREP could show significant benefits in enhancing exercise capacity, lung function, and quality of life, while diminishing the occurrence of PPCs and mitigating the levels of anxiety and depression, future large RCT need to further explore the efficacy. Trial registrationThis study was registered with the China Clinical Trial Registration Center (ChiCTR) under the Clinical Trial Registration Number [ChiCTR2200066698].

Integrating palliative care education in pulmonary rehabilitation: a randomized controlled study protocol

BackgroundPalliative care addresses multiple unmet needs of people with chronic obstructive pulmonary disease (COPD) or interstitial lung diseases (ILD) and their family and/or friend caregivers, but it remains highly underused. Pulmonary rehabilitation (PR) may provide a key opportunity to introduce palliative care. We aim to explore the effects of palliative care education as part of PR on knowledge about this field in people with COPD or ILD and their family and/or friend caregivers.MethodsA randomized controlled study will compare PR with palliative care education (experimental) with traditional PR (control) in people with COPD or ILD and their family and/or friend caregivers. Family and/or friend caregivers will be invited to take part in education and psychosocial support sessions. In addition to the usual educational content, the experimental group will have a session on palliative care, a “Peer-to-peer session”, two “Get-apart sessions” and online sessions. The “Peer-to-peer session” and the “Get-apart sessions” will be discussions about topics suggested by participants. The “Get-apart sessions” will be dedicated to people with COPD or ILD apart from their family and/or friend caregivers and vice versa. The online sessions will be zoom meetings to discuss any health-related issues raised by participants, at a flexible time. A mixed-methods approach will be used to evaluate the outcomes. The primary outcome will be knowledge about palliative care. Secondary outcomes will include attitude towards palliative care referral, symptoms, disease impact, health-related quality of life, needs, knowledge about the disease, burden of providing care, adherence, adverse events and referral to a specialist palliative care team. Quantitative and qualitative data will be collected at baseline and end of PR. At 6-months post-PR, only patient-reported outcomes will be collected. For the primary outcome, time*group interaction will be analyzed with mixed analysis of variance.DiscussionThis study aims to demonstrate the impact of integrating palliative care into the PR education program.Trial registrationThe trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 1st September, 2023 (NCT06046547).

Mixed-Methods Assessment of a Virtual Reality-Based System for Pulmonary Rehabilitation.

Barriers to pulmonary rehabilitation (PR) (e.g., finances, mobility, and lack of awareness about the benefits of PR). Reducing these barriers by providing COPD patients with convenient access to PR educational and exercise training may help improve the adoption of PR. Virtual reality (VR) is an emerging technology that may provide an interactive and engaging method of supporting a home-based PR program. The goal of this study was to systematically evaluate the feasibility of a VR app for a home-based PR education and exercise program using a mixed-methods design. 18 COPD patients were asked to complete three brief tasks using a VR-based PR application. Afterward, patients completed a series of quantitative and qualitative assessments to evaluate the usability, acceptance, and overall perspectives and experience of using a VR system to engage with PR education and exercise training. The findings from this study demonstrate the high acceptability and usability of the VR system to promote participation in a PR program. Patients were able to successfully operate the VR system with minimal assistance. This study examines patient perspectives thoroughly while leveraging VR-based technology to facilitate access to PR. The future development and deployment of a patient-centered VR-based system in the future will consider patient insights and ideas to promote PR in COPD patients.

Comparing the effects of smartphone-based and face-to-face pulmonary rehabilitation education on caregiver burden and quality of life among the family caregivers of patients with chronic obstructive pulmonary disease: a randomized controlled field trial

BackgroundFunctional limitation among patients with chronic obstructive pulmonary disorder (COPD) and their dependence on their family caregivers (FCs) can significantly increase caregiver burden (CB) and reduce the quality of life (QOL) among FCs. Education of pulmonary rehabilitation (PR) to FCs is a strategy with potential positive effects on CB. This study was conducted to compare the effects of smartphone-based and face-to-face (FTF) PR education on CB and QOL among the FCs of patients with COPD.MethodsThis randomized controlled field trial was conducted in 2021–2022. Participants were purposefully selected from the PR unit of Khorshid comprehensive respiratory care clinic in Isfahan, Iran, and randomly allocated to a control and an intervention group. Participants in the control group received PR education in twelve 30–60-min FTF sessions held twice weekly in six consecutive weeks. Their counterparts in the intervention group received PR education for 6 weeks through an android application. The Zarit Burden Interview and the 12-item Short Form Health Survey (SF-12) were used for data collection before and immediately after the study intervention. The SPSS software (v. 24.0) was used to analyze the data through the independent-sample t, paired-sample t, chi-square, and Fisher’s exact tests.ResultsThe means of participants’ age was 47.7 ± 13.8 years in the control group and 44.1 ± 14.8 years in the intervention group. Most participants in these groups were female (82.9% vs. 71.4%). The pretest mean scores of CB and QOL were respectively 50.77 ± 10.64 and 27.82 ± 3.9 in the control group and 49.77 ± 7.65 and 26.71 ± 3.5 in the intervention group with no significant between-group difference (P > 0.05). At the posttest, these values were respectively 51.57 ± 7.32 and 27.74 ± 3.28 in the control group and 37.31 ± 6.95 and 34.37 ± 2.8 in the intervention group, and between-group differences were significant (P < 0.05). The mean scores of CB and QOL did not significantly change in the control group (P > 0.05), but respectively decreased and increased significantly in the intervention group (P < 0.05).ConclusionsSmartphone-based PR education is effective in significantly decreasing CB and improving QOL among the FCs of patients with COPD.Trial registrationIranian Registry of Clinical Trials IRCT20161203031200N3

The RECHARGE-IPCRG ‘Teach the Teacher’ programme: building capacity for pulmonary rehabilitation in low- and middle-income countries

Introduction Chronic respiratory diseases are the most common causes of morbidity and mortality globally. Pulmonary rehabilitation (PR) is a low-cost, high-impact intervention with patient education and exercise at its core. Although supported by a well-established evidence base, demand greatly exceeds capacity in low- and middle-income countries (LMIC), including limited workforce training opportunities to support PR development and implementation. The International Primary Care Respiratory Group’s (IPCRG) Teach the Teacher (TtT) is an established education programme designed to build sustainable local clinical teaching and delivery capacity. Methods A collaboration between the National Institute for Health and Care Research (NIHR) funded Global RECHARGE Group for PR and IPCRG to deliver a ‘Teach the Teacher’ (TtT) programme for PR capacity building. Our Tier 1 TtT programme combined educational and PR service development concepts with core clinical content adapted for RECHARGE partners in India (Pune and Delhi), Sri Lanka, Kyrgyzstan and Uganda. Due to the severe acute respiratory syndrome coronavirus-2 (SARS‑CoV‑2) pandemic, the programme was adapted to a digital environment using online platforms such as Zoom video conferencing and Google Classroom. We used an adapted framework to evaluate professional learning and its impact. Findings Fifteen Tier 1/local leader participants attended a sixteen-hour online programme in September-October 2021. Participants included nurses, physiotherapists, doctors and early career health professionals/researchers. As local leaders in PR, participants created a tiered teaching programme for developing a critical mass of PR expert teachers, contextualised to their local healthcare systems and cultures. Participants also explored how to engage and influence multiple professional groups and stakeholders to support the widespread sustainable implementation of PR. Conclusions The RECHARGE-IPCRG TtT programme provided a clear education and service development framework to support PR capacity development in LMIC. We address a lack of empirical evidence concerning capacity-building initiatives by being explicit about the programme’s learning design, management and evaluation. A whole system perspective to PR allowed consideration of health systems, culture, referral pathways and scalability. Sustainable national PR education programmes will require additional resources and a long-term strategy, potentially aligning with the TtT three-tier cascade model.

Referral of patients with chronic obstructive pulmonary disease to pulmonary rehabilitation from primary care: A local survey of GPs and practice nurses

Aim To gain an understanding of the referral practices of local general practitioners (GPs) and practice nurses (PNs) to a local pulmonary rehabilitation (PR) programme in order to improve referral rates of patients with chronic obstructive pulmonary disease (COPD). Methods The study involved a cross-sectional survey of local GP and PNs from 16 GP practices within a local health and social care trust. The survey was distributed electronically and in hard copy form to GP practices and a 1-month period was provided to complete the survey. Inclusion/exclusion criteria GPs and PNs who review patients with COPD were eligible to complete the survey. Outcome measures The study reports on descriptive statistics for perceived referral rates to PR, knowledge of PR referral process within the local area, service user barriers, referral barriers and strategies to improve referral. Inferential statistics were used to determine if differences existed between GPs and PNs with regards MRC questioning and PR education. Results The survey was distributed to a total of 70 people, with responses received from 13 general practitioners (GPs) and 11 practice nurses. The overall response rate for the survey was 34%, with a GP response rate of 23% versus a PN response rate of 79%. 83% percent (n = 20) of respondents estimated they referred &lt;50% and 17% (n = 4) did not refer any COPD patients to PR. The number of PNs who reported that they question service-users around exertional breathlessness and educate around the benefits of PR was significantly higher than participating GPs (p &lt;0.05). 63% (n = 15) of respondents felt that the principal barrier to PR referral was patient unwillingness/refusal to attend. 29% (n = 7) of respondents felt that information leaflets/posters would improve referral rates to PR. Conclusions In this local survey referral from primary care to PR in the COPD population was underutilised by clinicians. PNs reported that they were more likely than GPs to explore patient’s exertional breathlessness and to educate patients regarding the benefits of PR. Respondents perceived that patient unwillingness to attend PR was the primary barrier however practitioner referral barriers in the form of time constraints were also cited. Respondents also cited a perceived lack of patient understanding of the benefits of PR as a factor affecting PR attendance.

How is the education component of pulmonary rehabilitation delivered in practice--Is it patient-centred?

Pulmonary rehabilitation (PR) involves a significant component of education, but little has been published on what educational content is covered or how it is delivered. This survey study set out to investigate how PR education is delivered in practice. A survey was designed to investigate the current educational delivery and which topics respondents reported should be included in a PR programme. The survey was sent to 11 Scottish PR Action group regional leads. Nine completed the questionnaire (81.8%). Education was reported to be predominately group-based and face-to-face (n=9, 100%) consisting of between 6 and 12 sessions. Most educational topics lasted 15min or less, some topic areas were not consistently covered. The educational content was variable and not personalised to individual needs. Three health areas undertook informal literacy assessment at baseline assessment and when tailoring COPD plans. Often attendance at educational sessions was not needed to 'complete' PR. Content and delivery of educational topics were varied, and no consistent outcome measure to assess the effectiveness of education was used. Education needs to be delivered in a patient-centred way tailoring for literacy skills using a range of different teaching approaches and aids.

Chronic Obstructive Pulmonary Disease Education in Pulmonary Rehabilitation. An Official American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report.

According to the 2013 American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation (PR), education to promote effective self-management is a cornerstone of this intervention. Despite education's stature within PR, there is currently limited evidence supporting its overall efficacy, and minimal evidence guiding its optimal design and delivery. This workshop was convened to focus on the current state of education in PR for patients with chronic obstructive pulmonary disease, who are the most common people referred to PR. The workshop explored the learning needs and limitations of patients participating in PR, promising design features (from work done outside of PR) that may inform our approach to education, and professional development of PR healthcare educators. Areas identified as needing development include: 1) outcome assessment for the educational component; 2) screening patients for conditions that will impede the learning process (anxiety, depression, cognitive deficits and health literacy issues); 3) tailoring content and optimizing delivery of the educational component; and 4) training PR professionals in their roles as educators. By necessity, the workshop conclusions are painted in broad strokes. However, with ongoing interest in improving quality through individualized patient assessment, educational design innovations, and scientific scrutiny comparable to that given to exercise training, the educational component of PR may achieve effective self-management, leading to successful behavior change and enhancement in health.

The role of pain in pulmonary rehabilitation: a qualitative study.

IntroductionOne third of individuals with chronic obstructive pulmonary disease (COPD) report pain. To help inform a COPD-specific pain intervention, we explored the views of health care providers (HCPs) and individuals with COPD on pain during pulmonary rehabilitation (PR).MethodsThis is a qualitative study using inductive thematic analysis. Eighteen HCPs familiar with PR and 19 patients enrolled in PR participated in semi-structured interviews. Demographic data were recorded, and the patients completed the Brief Pain Inventory (Short Form).Results1) Interaction between pain and COPD: pain is a common experience in COPD, heightened by breathlessness and anxiety. 2) Pain interfering with PR: a) Communicating pain: HCPs rarely ask about pain and patients are reluctant to report it for fear of being removed from PR. b) PR is a short-term aggravator but long-term reliever: although pain limits exercise, concentration, and program adherence, PR may reduce pain by increasing muscle strength and improving coping. c) Advice and strategies for pain: some attention is given to pain management but this is often counterproductive, encouraging patients to cease exercise. 3) An intervention to manage pain: HCPs were enthusiastic about delivering a pain intervention within their knowledge and time constraints. Early group education was preferred.ConclusionA pain intervention seems warranted in PR and may improve adherence and therefore clinical benefit. A pain intervention could be provided as part of PR education with HCP training.

Be honest and help me prepare for the future: What people with interstitial lung disease want from education in pulmonary rehabilitation.

Pulmonary rehabilitation (PR) is recommended for people with interstitial lung disease (ILD); however, the educational content of PR was not designed for this group. This study explored the perspectives of patients and ILD clinicians regarding the educational content of PR for ILD. A qualitative study using individual semi-structured interviews was undertaken. Transcripts were coded independently by two investigators and themes established by consensus. Participants were 18 people with ILD (9 idiopathic pulmonary fibrosis, diffusing capacity for carbon monoxide 54 (20)% predicted) and 14 clinicians from 5 countries and 5 disciplines. Major themes from patient interviews were the importance of knowing what the future might bring and the need for honesty from clinicians. Most were happy to attend standard PR education sessions but wanted ILD-specific content. Patients wanted information about end-of-life planning and most were happy to discuss it in a group. Among clinicians, there was no consensus regarding whether prognosis should be discussed in PR. Most clinicians supported discussion of advanced care planning, however, some thought it should not be discussed in a group. We conclude that people with ILD have specific educational needs that may not be met in the current PR format. Patients and clinicians have some discordant views about programme content.

Effects of pulmonary rehabilitation education for caregivers on pulmonary function and pain in patients with lung cancer following lung resection.

[Purpose] The purpose of this study was to evaluate the effects of a pulmonary rehabilitation education program for caregivers on patients who underwent lung resection surgery. [Subjects] Subjects who underwent lung resection by visual assisted thoracotomy (VATs) were selected and divided into a control group of 19 and an experimental group of 22. [Methods] The experimental group received a pulmonary rehabilitation education program for caregivers, while the control group received typical care for 4 weeks. This study assessed the subjects 2 weeks (baseline) and 6 weeks after surgery (4 weeks). The forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were measured to evaluate pulmonary function. A visual analogue scale (VAS) was utilized to evaluate pain. [Results] Pulmonary function (FVC and FEV1) increased more in the experimental group compared with the control group. Furthermore, VAS scores were lower in the experimental group compared with the control group. [Conclusion] A pulmonary rehabilitation education program for caregivers had a positive effect on pulmonary function in patients with lung cancer after lung resection.

A study of Effects of Video Pulmonary Rehabilitation Education Program in COPD patients

A study of Effects of Video Pulmonary Rehabilitation Education Program in COPD patients

Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives

Background: Advance care planning is considered to have an important role in the management of people with chronic lung disease; however, uptake in clinical practice remains limited. Participant acceptance of the inclusion of an advance care planning information session in pulmonary rehabilitation and maintenance programmes could support a practical solution. Aim: To evaluate the introduction of a structured group advance care planning information session from the perspective of participants in pulmonary rehabilitation and maintenance programmes. Design: Prospective qualitative study with semi-structured interview transcripts analysed using iterative thematic analysis. Setting/participants: Participants in pulmonary rehabilitation and maintenance programmes at a tertiary metropolitan hospital and two affiliated community sites. Results: Sixty-seven participants with a range of chronic lung diseases were interviewed with ages ranging from 39 to 88 years, forced expiratory volume in 1 s (FEV1) ranging from 18% to 130% predicted and 6-min walk distance ranging from 105 to 619 m. Sixteen participants (24%) had previously heard of advance care planning. Major themes were that participants valued the advance care planning information and thought pulmonary rehabilitation was an appropriate setting. The group education format was well accepted and perceived to have advantages over individual sessions. Participants were happy to receive the information from a non-medical facilitator. Non-attendees had usually missed the session for reasons unrelated to content. A small number of participants felt advance care planning was not appropriate for them, but all recognised its value for other participants. Conclusions: Participants in our pulmonary rehabilitation and maintenance programmes value the opportunity to participate in a structured, group-based advance care planning session. Consideration should be given to broader inclusion of advance care planning education into existing pulmonary rehabilitation and maintenance programmes for people with chronic respiratory disease.

Reporting participation rates in studies of non-pharmacological interventions for patients with chronic obstructive pulmonary disease: a systematic review

BackgroundPulmonary rehabilitation (PR) and self-management (SM) support programmes are effective in the management of patients with chronic obstructive pulmonary disease (COPD), but these interventions are not widely implemented in routine care. One reason may be poor patient participation and retention. We conducted a systematic review to determine a true estimate of participation and dropout rates in research studies of these interventions.MethodsStudies were identified from eight electronic databases including MEDLINE, UK Clinical Trial Register, Cochrane library, and reference lists of identified studies. Controlled clinical trial studies of structured SM, PR and health education (HE) programmes for COPD were included. Data extraction included ‘participant flow’ data using the Consolidated Standards of Reporting Trials (CONSORT) statement and its extension to pragmatic trials. Patient ‘participation rates’ (study participation rate (SPR), study dropout rate (SDR) and intervention dropout rate (IDR)) were calculated using prior participation definitions consistent with CONSORT. Random effects logistic regression analysis was conducted to examine effects of four key study characteristics (group vs. individual treatment, year of publication, study quality and exercise vs. non-exercise) on participation rates.ResultsFifty-six quantitative studies (51 randomised controlled trials, three quasi-experimental and two before-after studies) evaluated PR (n = 31), SM (n = 21) and HE (n = 4). Reports of participant flow were generally incomplete; ‘numbers of potential participants identified’ were only available for 16%, and ‘numbers assessed for eligibility’ for only 39% of studies. Although ‘numbers eligible’ were better reported (77%), we were unable to calculate SPR for 23% of studies. Overall we found ‘participation rates’ for studies (n = 43) were higher than previous reports; only 19% of studies had less than 50% SPR and just over one-third (34%) had a SPR of 100%; SDR and IDR were less than or equal to 30% for around 93% of studies. There was no evidence of effects of study characteristics on participation rates.ConclusionUnlike previous reports, we found high participation and low dropout rates in studies of PR or SM support for COPD. Previous studies adopted different participation definitions; some reported proportions without stating definitions clearly, obscuring whether proportions referred to the study or the intervention. Clear, uniform definitions of patient participation in studies are needed to better inform the wider implementation of effective interventions.

S112 Estimating Participation Rates of COPD Patients in Pulmonary Rehabilitation and Self-Management Programmes: The Importance of Defining Participation

Introduction and ObjectivesDelivery of pulmonary rehabilitation (PR) and self-management (SM) support programmes to patients living with chronic obstructive pulmonary disease (COPD) is emphasised in national guidelines, but these interventions are...

Assessing Education in Pulmonary Rehabilitation: The Understanding COPD (UCOPD) Questionnaire

There is currently no questionnaire available that comprehensively assesses patients’ understanding, self-efficacy and satisfaction with the education component of pulmonary rehabilitation. The aim of this study was to develop the Understanding COPD (UCOPD) questionnaire. The key stages in the development of the UCOPD questionnaire were: (i) Generation of questions, and assessment of face and content validity, user-centredness, acceptability and feasibility; (ii) Assessment of plain English and readability; (iii) Assessment of structural validity; (iv) Assessment of test-retest reliability and internal consistency; (v) Assessment of the responsiveness, convergent validity and floor and ceiling effects. The UCOPD questionnaire assesses understanding, self-efficacy and use of key self-management skills (Section A) and satisfaction (Section B). It has good validity and practical properties, and readability was acceptable. It has good test-retest reliability (Section A: ICC range: 0.87 to 0.96; Section B: Wilcoxon: p > 0.05) and internal consistency (Cronbach's Alpha range: 0.78 to 0.95). It is responsive to pulmonary rehabilitation (Mean change: About COPD: 18.26 [12.12 to 24.40]%, Managing Symptoms 20.94 [13.86 to 28.01]%, Accessing Help and Support 24.06 [14.53 to 33.60]%, Total 20.59 [14.43 to 26.75]%, p < 0.001). It had a moderate correlation with the Bristol COPD Knowledge Questionnaire (BCKQ): pre-pulmonary rehabilitation: r = 0.41, p = 0.02; post-pulmonary rehabilitation: r = 0.35, p = 0.047. In conclusion, the UCOPD questionnaire offers the opportunity to assess the benefit of the education component of pulmonary rehabilitation in terms of its effect on understanding, self-efficacy and satisfaction. Further research is needed across different pulmonary rehabilitation settings to demonstrate the robustness of the UCOPD questionnaire, and to establish the minimum clinically important difference.

P223 End of life discussion in pulmonary rehabilitation: too scary or worth a try?

Background End of life is a topic which may be included in pulmonary rehabilitation (PR) education sessions. Patient expectations from such a session, its optimal content, and who should deliver it is unknown. Method The community PR programme in Hammersmith and Fulham has included a session entitled “Managing the Final Stages of COPD” since April 2010. Apprehensions and training needs around this subject were identified in respiratory staff running PR and therefore a community matron with an interest in palliative and end of life care led the sessions. Twelve–sixty min end of life discussion sessions were delivered from April 2010 to June 2011. The content was based around the eponymous British Lung Foundation (BLF) leaflet. Discussions focused principally on making a will, arranging a funeral and considering a Power of Attorney or Advance Decision. Participants were given advance notice and an opportunity to “opt out”. Results 72 patients attended these sessions (average number 6). None opted out. One patient asked for more information afterwards. Two partcipants became upset during the session; one opted to attend in spite of a recent bereavement and the other reported “feeling relieved”. Evaluation responses are shown in Abstract P223 table 1. Conclusion Advanced care planning is well received and can be delivered as part of community PR education. Respiratory staff leading PR are now confident about delivering this themselves. However this setting is not able to address the advanced care planning needs of specific patients with adverse prognostic indicators and this needs separate planning.

P144 Evaluation of multidisciplinary pulmonary rehabilitation education delivered by either DVD or spoken talk

IntroductionEducation is a core component of a multidisciplinary Pulmonary Rehabilitation (PR) programme. It is commonly delivered as a spoken session. This can create delivery problems when speakers are unavailable, and...

A cluster randomised controlled trial evaluating the effectiveness of a structured pulmonary rehabilitation education programme for improving the health status of people with chronic obstructive pulmonary disease (COPD): The PRINCE Study protocol.

BackgroundA key strategy in improving care for people with chronic obstructive pulmonary disease (COPD) is the provision of pulmonary rehabilitation programmes. Pulmonary rehabilitation programmes have been successful in improving patients' sense of dyspnoea and Health Related Quality of Life. However, the effectiveness of structured education pulmonary rehabilitation programmes delivered at the level of the general practice on the health status of people with COPD remains uncertain and there is a need for a robust and fair assessment of this. The PRINCE study will evaluate the effectiveness of a Structured Education Pulmonary Rehabilitation Programme (SEPRP), delivered at the level of the general practice, on the health status of people with COPD.Methods/DesignThe PRINCE Trial is a two-armed, single blind cluster randomised trial conducted in the primary care setting in Ireland. Randomisation to control and intervention is at the level of the General Practice. Participants in the intervention arm will receive a SEPRP and those allocated to the control arm will receive usual care. Delivery of the SEPRP will be by a practice nurse and physiotherapist in the General Practice (GP) site. The primary outcome measure of the study will be health status as measured by the Chronic Respiratory Questionnaire (CRQ). Blinded outcome assessment will be undertaken at baseline and at twelve-fourteen weeks after completion of the programme. A comparison of outcomes between the intervention and control sites will be made to examine if differences exist and, if so, to what extent between control and experimental groups. Sample size calculations estimate that 32 practices with a minimum of 10 participants per practice are required, in total, to be randomised to control and intervention arms for power of at least 80% with alpha levels of 0.05, to determine a clinically significant change of 0.5 units in the CRQ. A cost effectiveness analysis will also be conducted.DiscussionThe results of this trial are directly applicable to primary care settings in Ireland. Should a SEPRP delivered by practice nurses and physiotherapists in primary care be found to be effective in improving patients' sense of dyspnoea and HRQoL, then the findings would be applicable to many thousands of individuals in Ireland and beyond.Trial registrationISRCTN: ISRCTN52403063

Education in Pulmonary Rehabilitation: The Patient’s Perspective

Wilson JS, O’Neill B, Reilly J, MacMahon J, Bradley JM. Education in pulmonary rehabilitation: the patient’s perspective. Objectives To ascertain from patients’ perspectives what should be included in the educational component of pulmonary rehabilitation and how it should be delivered, and to compare those perspectives with the views of health professionals. Design Qualitative research method using focus groups of patients and health professionals. Setting A regional respiratory center and outpatient clinic. Participants Purposive samples of 32 patients with chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second, 18%–67% predicted) divided into 6 focus groups; 8 health professionals knowledgeable about COPD and pulmonary rehabilitation who attended a multidisciplinary focus group meeting. Interventions Participants attended focus group meetings (2–3h) guided by a series of questions and topics; results were posted to the participants for their verification. Main Outcome Measure The educational content of a pulmonary rehabilitation program. Results Deficits in patients’ knowledge, understanding, and management of their disease were identified. Six key educational topics resulted: disease education, management of breathlessness, management of an exacerbation, medication, psychosocial support, and welfare and benefits systems. Patients and health professionals preferred group information sessions provided by knowledgeable people speaking layman’s language, with oral presentations being supplemented by written information. Conclusions Gaining a greater understanding of patients’ educational needs permits health professionals who design pulmonary rehabilitation programs to include these requirements in a format that is acceptable to patients. The key topics, content, and format for delivery of the educational component for pulmonary rehabilitation were identified. Future research should focus on the development of an educational package and assessment of its efficacy, which would facilitate equitable patient access to education in pulmonary rehabilitation.