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Developing the ‘Adapted Pulmonary Rehabilitation (APR) Programme’

Background

Pulmonary rehabilitation is a programme of supervised exercise and education for people with disabling breathlessness. 

The education component of many pulmonary rehabilitation programmes is delivered in a didactic fashion which does not lead to reliable behaviour change or maintenance.

Evidence shows that the benefits in exercise capacity and quality of life that are consistently reported on completion of pulmonary rehabilitation typically dissipate by one year and attendance is often irregular. 

To address these issues we integrated self-management skills training into the education component of an existing pulmonary rehabilitation programme replacing the didactic education sessions.

What we did

A key focus for the CSMS team in its work with patients and clinicians has been the creation of a personal health plan (PHP) for patients, together with the development of comprehensive training materials produced in conjunction with members of Breathe Easy and clinicians.

The innovative Adapted Pulmonary Rehabilitation (APR) programme focused on key self management skills including goal setting and problem solving, was built around personal health planning and was delivered in the existing respiratory care pathway.

The Adapted Pulmonary Rehabilitation (EPR) programme is a rolling programme delivered over 12 sessions consisting of one hour of exercise and one hour of education. It is delivered by a patient lead and physiotherapist, with support from a patient with expertise in self-management skills who leads a session on their personal experience, the skills they use, and how these help to manage their condition.

Unlike standard pulmonary rehabilitation, APR combines COPD education with self-management skills training and support, which aims to enhance self-efficacy and problem solving skills.

The personal health plan (PHP) is introduced in a pre-course one-to-one assessment session and is used as a reference throughout the course. The PHP provides a key tool to support behaviour change during and after the programme. Patients record agendas, goals, action plans, diaries and logs and are encouraged to use the PHP to monitor and plan their activities.

Impact

Initial evidence indicates that following APR patients were more confident and motivated to self manage their condition. 

Focusing on the PHP as the central component of the programme should set the context for teaching self-management skills and offers each patient a toolkit which can be referenced after they have finished.

Patient feedback has been very positive and tutors have seen group intervention in goal setting and follow-up engender high engagement levels in individuals. Even the most ambivalent and reluctant patient has set a personal goal.

Patient M said that the programme had changed her life to the extent that she was close to giving up smoking, something that she never thought possible.

Patient B struggled with the process as it reminded him of his job in sales but then admitted to the group that it worked. He said the programme had made a big difference to him, “I didn’t think the goal setting was for me at first but it really works doesn’t it – coming here has really helped, now I want to get on and live my life.”

Patient P managed to get to Tesco on the bus for the first time in several months and said her confidence had improved.

Learning from EPR is transferable to other condition specific rehabilitation programmes where behaviour is a key factor, such as cardiac rehabilitation and diabetes support.

We have a robust evaluation of this process, including case studies, Qualitative interviews and quantitative feedback; this includes how patients went onto do after the course had ended and if they used the tools taught to them in the programme. One of the challenges realised is how the personal health plan is used after the programme. During the programme it was used as a tool for learning and reference, after the course it is not used by many patients who attend the programme. This is reflected in the overall challenge of self management.

As a centre we are continuing to understand what help patients and carers need to continue to support their own health.