Chronic respiratory disease (FS-04)

Chronic respiratory disease: high-quality evidence supports greater physiotherapy intervention

Mark Elkins (Australia), Susan Jenkins (Australia), Judy Bradley (United Kingdom), Camila Schivinski (Brazil)

Focused symposium

Sunday 3 May 2015, 13:45-15:15, Hall 406

Chronic respiratory disease: high-quality evidence supports greater physiotherapy intervention

Elkins M. 1,2, Jenkins S. 3,4, Bradley J. 5, Schivinski C. 6

1The George Institute for Global Health, Centre for Evidence-Based Physiotherapy, Sydney, Australia, 2University of Sydney, Sydney Medical School (Central), Sydney, Australia, 3Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 4Sir Charles Gairdner Hospital, Physiotherapy Department, Perth, Australia, 5University of Ulster, Health and Rehabilitation Sciences Research Institute, Belfast, United Kingdom, 6Universidade do Estado de Santa Catarina, Centro de Educação Física e Desportos, Florianopolis, Brazil

Learning objectives

  1. Understand the morbidity caused by chronic respiratory diseases (CRDs) throughout life.
  2. Comprehend the range of physiotherapy interventions that reduce morbidity and improve function in people with CRD.
  3. Learn ways to deliver these interventions to maximise the clinical benefits from available resources.

Description

Globally, over 400 million people have chronic respiratory diseases (CRDs), which include chronic obstructive pulmonary disease (COPD), interstitial lung disease, bronchiectasis, asthma, cystic fibrosis, and bronchopulmonary dysplasia. Depending on the specific pathology, symptoms may include breathlessness, wheeze, sputum production, fatigue, reduced exercise tolerance, psychological sequelae and poor health-related quality of life. Deconditioning is common, partly because breathlessness reduces the willingness to undertake physical activity. CRDs are often characterised by acute exacerbations, which typically consume extensive healthcare resources.

Many physiotherapy interventions have worthwhile benefits in CRD: easing symptoms, reversing muscle deconditioning, improving self-management through education, reducing the risk of acute exacerbations, and managing the acute exacerbations that do occur. Despite these benefits, many patients do not receive physiotherapy intervention, either because physiotherapists remain unaware of the benefits or because resources are limited. This symposium will tackle both issues by summarising evidence of effective physiotherapy interventions and highlighting novel ways to deliver interventions more efficiently with limited resources.

Pulmonary rehabilitation is an evidence-based intervention for people with CRD. The benefits include reduced breathlessness and fatigue, increased exercise tolerance, and improved well-being. In people with COPD, rehabilitation reduces healthcare utilisation. A/Prof Sue Jenkins will provide an overview of the evidence for the benefits of pulmonary rehabilitation in individuals with a range of CRDs. Strategies will be outlined for implementing rehabilitation in a variety of settings including within the community. For example, ground-based walking training is an effective intervention that requires no equipment and is easily transferrable to the community setting. Where the number of therapists is limited, group training can be used and has additional advantages such as motivation and social support. Where transport is limited, remote monitoring/advice can be provided. Where patients have comorbidities that limit exercise on land, water-based pulmonary rehabilitation is also effective. Methods of maintaining the benefits of rehabilitation will also be discussed.

Prof Judy Bradley will review the high-quality evidence for airway clearance interventions (including manual airway clearance techniques, positive pressure devices, non-invasive ventilatory support, and exercise) and factors that should inform the choice and frequency of airway clearance. Although strong evidence exists for most of these interventions in specific settings, this section of the symposium will include careful delineation of where evidence is supportive, where it is not, and where it is lacking - guiding where further research should be focused. The cost of these interventions will be considered and low-cost options for these interventions will be discussed.

People with CRD typically could benefit from prolonged use of medication, exercise and other physiotherapy interventions. A/Prof Mark Elkins will talk about structuring a treatment session so that the interactions between these three elements maximise the overall clinical benefits obtained. Strategies include, eg, how body position or breathing pattern can improve deposition of an inhaled medication and how timing medication delivery in relation to exercise can maximise the benefit from each of these interventions. Examples involving low cost medications and therapies will be a focus. This structuring involves minimal input from the physiotherapist and no ongoing cost to the patient, but it can make a large and lasting difference to the clinical effect. One issue with long-term use of these time-consuming therapies is poor adherence. Therefore, strategies for ordering, timing and overlapping the interventions to reduce the overall treatment time and optimise adherence with self-management will also be presented.

A/Prof Camila Schivinski will focus on children with CRDs - presenting the evidence regarding the physiotherapy techniques established in paediatrics, as well as aspects that still require investigation. This section will therefore highlight certain conditions that are more common in childhood, special age-related considerations when assessing physical and respiratory function and applying physical therapies in children, motivational strategies when therapies are used long-term, and how anatomical and physiological differences between children and adults influence physiotherapy input.

Implications / Conclusions

Physiotherapists can implement effective pulmonary rehabilitation for greater numbers of people with CRD within existing resources by embracing new models of delivery. Physiotherapists can use a range of low-cost interventions to help manage airway clearance in CRDs. The benefits of exercise and other physiotherapy interventions for CRD can be maximised by careful coordination with pharmacological therapies, including some very low-cost medications. Paediatric respiratory conditions are also amenable to physiotherapy interventions.

Keywords

Chronic respiratory disease; Chronic disease self-management; Exercise

Funding acknowledgements

Nil

Relevance to WCPT and expected audience

Globally, >400 million people have chronic respiratory disease, representing immense morbidity, massive healthcare expenditure, and the third highest cause of premature deaths. Numerous physiotherapy interventions are effective for chronic respiratory disease, but many patients do not receive them, either because physiotherapists remain unaware of their potential role or because healthcare resources are limited. This symposium will tackle both issues by summarising evidence of effective physiotherapy interventions and highlighting novel ways to deliver interventions more efficiently.

Target audience

Clinical physiotherapists (adult/paediatric, inpatient/outpatient/community-based) whose patients include those with chronic respiratory disease; managers and educators of these physiotherapists; and physiotherapy researchers and policymakers.