D1.4 Physiotherapist

Physiotherapists are involved in a broad range of areas, including exercise testing and training, assessment for oxygen therapy, patient education, sputum clearance, breathing retraining, mobility, non-invasive ventila­tion (NIV), postoperative respiratory care (eg, after LVRS), and assessment and treatment of musculoskeletal disorders com­monly associated with COPD.

A cluster randomised controlled trial evaluated the effectiveness of a structured education pulmonary rehabilitation program in 32 general practices in the Republic of Ireland (Casey 2013). Physiotherapists and practice nurses with no prior COPD expertise were trained to deliver a structured education pulmonary rehabilitation programs in the General Practice (GP) sites to people with moderate and severe COPD, thereby increasing local accessibility. However, the CIs for the total CRQ change scores and the CRQ Dyspnoea and CRQ Physical subscale change scores do not exclude a smaller difference than the one that was pre-specified as clinically important.

Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist (Holland 2017). The primary outcome was change in 6 minute walk distance (6MWD). This home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation.

For patients hospitalised with a COPD exacerbation, exercise, neuromuscular electrical stimulation, breathing exercises, and chest therapy significantly improved their functional status compared with standard care.