What is Pulmonary Rehabilitation (PR)?
PR is an exercise and education programme designed for people with lung disease who experience symptoms of breathlessness.
PR focuses on tailored physical exercise and information that helps people to better understand and manage their condition/s and symptoms, including feeling short of breath. It’s included as a key intervention in the NHS Long Term Plan, which has made respiratory disease a new national clinical priority. Most people who go to PR have chronic obstructive pulmonary disease (COPD), but people with other long-term lung conditions, such as bronchiectasis and pulmonary fibrosis, can also benefit. A PR course typically lasts six to eight weeks, with two sessions of around two hours each week, and includes an individually prescribed exercise and education programme including aerobic exercise and resistance training and lifestyle support.
PR courses are delivered in groups of 8-16 people and may be held in local hospitals, community halls, leisure centres and health centres. Each course is supported by a PR team made up of trained health care professionals such as physiotherapists, nurses and occupational therapists.
Evidence shows that accessing PR improves people’s ability to walk further, helps them feel less tired and breathless when carrying out day-to-day activities 90 per cent of patients who complete a PR programme have higher activity and exercise levels, and report an improved quality of life.
PR has been shown to support better self-management and reduction in exacerbations, reduction in numbers of acute and emergency admissions and reduction in primary care appointments.
Our work on PR
Respiratory disease has been identified as a clinical priority within the NHS Long Term Plan, which sets out the ambitions for the NHS over the next 10 years. Expansion of PR services is one of the key commitments of the Plan and the cardiovascular disease and respiratory programme. NHS England aims to increase the number of people referred to PR and those who complete PR programmes, particularly amongst those groups who are less likely to access this service.
To support this expansion, the GP Contract includes a Quality Outcome Framework (QOF) incentive to encourage referrals to PR services. Transformation funding for PR has been provided to support expansion of services, improve equity of access for disadvantaged population groups and to raise the quality of services provided. Examples of good practice in widening access to PR services are being identified so that they can be shared widely. Work is underway to identify solutions to workforce shortages in PR. This will include sharing good practice around attracting staff and students to PR, creating progression opportunities and increasing the range of professionals who can support PR, for example, exercise specialists. Guidance will be developed on developing multi-professional teams for PR.
To help measure progress made in increasing uptake and completion of PR, data obtained from ongoing national audits will be available to NHS England. In addition, a tool is being developed to display the prevalence of COPD in a geography, together with a forecast of the number of people likely to be referred to PR, how many are likely to start, and numbers completing. Systems and regional respiratory networks will be able to access these data to support local planning and improvements.
PR services are commissioned by systems. Systems buy services for their local community from any service provider that meets NHS standards. Commissioning standards are being developed to provide guidance on what PR services should have in place or work to achieve. These include a good understanding of local population needs, informed by data and other intelligence; special attention to increasing access to PR services and providing suitable options to people; providing quality services through accreditation; and maintaining a sufficient, skilled workforce.
The National COPD Audit Programme in 2017 identified 195 separate PR services, delivered by 158 different provider organisations in place across England. The majority of services are provided by NHS trusts and health boards, but providers also included charities, community interest companies and private providers.
NICE has published quality statements related to people with stable COPD and exercise limitation due to breathlessness and those admitted to hospital for an acute exacerbation of COPD.
PR services are encouraged to participate in the National Respiratory Audit Programme (NRAP) which involves data collection relating to service provision and delivery of PR services for COPD in England and Wales. We are working to extend the scope of data collection to other lung conditions. PR Services can also join the Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS). The aim of the scheme is to improve the quality of pulmonary rehabilitation services throughout the UK through the process of accreditation. The scheme is run by the Royal College of Physicians and runs in collaboration with NRAP.