To mark Pulmonary Rehabilitation Awareness Week, Professor Sally Singh talks about her entry into the specialism and why it continues to be a highly valued intervention for people with chronic respiratory disease.
When I started my career there were very few centres offering pulmonary rehabilitation (PR). However, the concept of delivering exercise-based interventions for individuals with respiratory disease is not new – there are historical accounts of exercise rehabilitation for people with residual lung problems following tuberculosis. NHSE/I recognise the importance of PR and are currently investing in services to expand their programmes to reach more people who need it.
My journey in this field started with my PhD, where I developed a walking test to assess functional capacity of individuals with respiratory disease. An obvious test bed for this measure was pulmonary rehabilitation.
I was supported and mentored by Professor Mike Morgan, who was passionate about delivering PR and researching the intervention and how it is best delivered. Together, we set up a service at Glenfield Hospital in Leicester. The service was modest in the early days but has expanded to numerous other sites across Leicester and Leicestershire.
Pulmonary rehabilitation is now a well-developed service and there are over 200 sites across England and Wales, although capacity remains a challenge. Only a small percentage of eligible people are referred to a rehabilitation programme. What we do know, is that the impact of taking part in a rehabilitation programme is significant – people have an improved exercise capacity so can do more of the things that are important to them, they experience reduced breathlessness, reduced hospital admissions and, if they are admitted, have a reduced length of stay. Importantly the National Audit Programme for Pulmonary Rehabilitation (part of the National Asthma and COPD Audit Programme) tells us that the services delivered across the country deliver similar results to those described in research studies. The vast majority of services take part in the national audit which allows each service to benchmark their programme against the national average.
At its heart, the national audit has a service improvement agenda to ensure everyone receives a high-quality service. The audit is complemented by the RCP Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS). PRSAS was launched in April 2018 with the aim of improving the quality of PR services throughout the UK – almost 100 services have been awarded accreditation or are currently working towards it. PRSAS extends beyond the clinical outcome data and ensures that all aspects of service delivery are of high quality. Examples of additional areas reviewed include workforce, staff training, maintaining participant respect and dignity, research, and innovation.
Both the national audit and accreditation programme are supported by a very strong evidence base. The quality standards driving the benchmarking have been derived from the evidence base guidelines which were developed by the British Thoracic Society. Indeed, pulmonary rehabilitation is one of a handful of services in the NHS that has evidence-based guidance, a national audit and accreditation programme. Together, this supports us all to provide high-quality care for adults with chronic respiratory disease.