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Pulmonary Rehabilitation Is Not Just an Exercise Program. Education Is a Critical Component

Sidnie Hess

James Lamberti

Steven Nathan

Gerilynn L. Connors


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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Hess S, Lamberti JP, Nathan S, Connors GL. 
INOVA Fairfax Hospital, Falls Church, VA, USA

BACKGROUNDComprehensive pulmonary rehabilitation is not just an exercise program. The components of comprehensive pulmonary rehabilitation (PR) are: education, therapeutic exercise, psychosocial intervention and long term adherence. If patients are expected to be compliant with their treatment program such as: medications, exercise, proper nutrition, adequate oxygenation, self management skills to life style changes, the patient has to be empowered through knowledge. This is the role of education in comprehensive pulmonary rehabilitation. At present, idiopathic pulmonary hypertension (PH) patients and those with associated pulmonary hypertension are referred to the Inova Fairfax Hospital (IFH) PR department from the PH Clinic in the Advanced Lung Disease Program.

METHODSA retrospective analysis was completed on educational outcome data on PH patients referred to PR from January through December 2009. The PH patients participated in comprehensive PR for 10 weeks, three days/week, with 20 hours of scheduled education. A total of 12 patients were referred and started PR, 3 were discharged and 9 patients had pre/post outcome data, 3 male and 6 female. The patient’s ages were 40 to 84 with a mean age of 59. The education outcome evaluated included: a pre and post 16 question knowledge test.

RESULTS9 of the 12 PH patients completed PR. 3 of the patients had idiopathic PAH and the 6 patients with associative PH had a primary diagnosis of: 2 with bronchiectasis, 2 with scleroderma, COPD, and post-inflammatory pulmonary fibrosis. The mean pulmonary diagnostic data was: FVC 2.02L, 64% predicted, DLCO 9.8 mL/mmHg/min, 41% predicted. 6 of the 9 patients never smoked and 3 were former smokers with a mean 13 pack year history. The mean knowledge test result was: pre 9 out of 16 or 56% predicated and post 14 out of 16 or 88% predicated.

COMMENTS AND CONCLUSIONS: The Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines (Chest 2007; 131:4S-42S) recommendation for education is that is should be an integral component of pulmonary rehabilitation, education should include information on collaborative self-management, and the prevention and treatment of exacerbations. The ATS/ERS Society Statement on Pulmonary Rehabilitation (Am J Respir Crit Care Med 2006; 173:1390-1413) recommendations for selfmanagement education is: 1. The educational component of pulmonary rehabilitation should emphasize selfmanagement skills. 2. Self-management should include an action plan for early recognition and treatment of exacerbations and discussions regarding end-of-life decision making. 3. In selected patients, instruction in breathing strategies and bronchial hygiene techniques should be considered. and 4. The transference of educational training and exercise adherence to the home setting should be emphasized. The outcome of the educational component of comprehensive pulmonary rehabilitation at IFH resulted in increased knowledge for patients with PH. There is limited research on the role of education on specific outcomes in pulmonary rehabilitation, especially in patients with PH. Opportunities for future research to standardize the pre/post educational test and to evaluate the long term benefits of education are needed.