Jennifer A Alison1,2, Zoe J McKeough1, Kylie Johnston3,4, Renae J McNamara5,6, Lissa M Spencer7, Sue C Jenkins8,9,10, Catherine J Hill11,12, Vanessa M McDonald13, Peter Frith14,15, Paul Cafarella16,17, Michelle Brooke18, Helen L Cameron-Tucker19,20,21, Sarah Candy22, Nola Cecins8, Andrew S L Chan23,24, Marita T Dale25, Leona M Dowman26, Catherine Granger27,28, Simon Halloran29, Peter Jung30, Annemarie L Lee31, Regina Leung32, Tamara Matulick33, Christian Osadnik34, Mary Roberts35,36, James Walsh37,38, Sally Wootton39, Anne E Holland12,31,40. 1. Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia. 2. Allied Health Professorial Unit, Sydney Local Health District, Sydney, New South Wales, Australia. 3. Physiotherapy Discipline, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. 4. International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia. 5. Department of Physiotherapy, Prince of Wales Hospital, Sydney, New South Wales, Australia. 6. Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia. 7. Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 8. Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 9. Institute for Respiratory Health, Perth, Western Australia, Australia. 10. School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. 11. Department of Physiotherapy, Austin Hospital, Melbourne, Victoria, Australia. 12. Institute for Breathing and Sleep, Melbourne, Victoria, Australia. 13. Priority Research Centre for Healthy Lungs, School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia. 14. School of Medicine, Flinders University, Adelaide, South Australia, Australia. 15. School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. 16. Department of Respiratory Medicine, Repatriation General Hospital, Adelaide, South Australia, Australia. 17. School of Health Sciences, Flinders University, Adelaide, South Australia, Australia. 18. Respiratory Coordinated Care Program, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia. 19. Physiotherapy Services, Royal Hobart Hospital, Hobart, Tasmania, Australia. 20. Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, Hobart, Tasmania, Australia. 21. School of Medicine, University of Tasmania, Hobart, Tasmania, Australia. 22. Department of Respiratory, Counties Manukau Health, Auckland, New Zealand. 23. Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia. 24. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. 25. Department of Physiotherapy, St Vincent's Hospital, Sydney, New South Wales, Australia. 26. Department of Physiotherapy and Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia. 27. Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia. 28. Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 29. Department of Physiotherapy, LungSmart Physiotherapy and Pulmonary Rehabilitation, Bundaberg, Queensland, Australia. 30. Department of Physiotherapy, Northern Health, Melbourne, Victoria, Australia. 31. Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia. 32. Department of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. 33. Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 34. Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia. 35. Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia. 36. Ludwig Engel Centre for Respiratory Research, The Westmead Centre for Medical Research, Sydney, New South Wales, Australia. 37. Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia. 38. School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia. 39. Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, New South Wales, Australia. 40. Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
Abstract
BACKGROUND AND OBJECTIVE: The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts. METHODS: The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts. RESULTS: The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. CONCLUSION: The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers.
BACKGROUND AND OBJECTIVE: The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts. METHODS: The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts. RESULTS: The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. CONCLUSION: The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers.
Authors: Narelle S Cox; Simone Dal Corso; Henrik Hansen; Christine F McDonald; Catherine J Hill; Paolo Zanaboni; Jennifer A Alison; Paul O'Halloran; Heather Macdonald; Anne E Holland Journal: Cochrane Database Syst Rev Date: 2021-01-29