1. REMOTE PULMONARY REHABILITATION A Model for Delivery
Jane Dernie
September 2010

2. Standard 4: Pulmonary rehabilitation Standard statement 4a Pulmonary rehabilitation is available within the NHS board to people with COPD who have an MRC dyspnoea scale score of 3 or more. Rationale Pulmonary rehabilitation delivered by a multidisciplinary team can improve the health-related quality of life, exercise capacity and breathlessness of people with COPD. There is good evidence to support the benefits of pulmonary rehabilitation post-exacerbation. Pulmonary rehabilitation has been shown to be an effective treatment for people with COPD. References: 4, 9, 10 Essential criteria 4a.1 Pulmonary rehabilitation is offered to people with COPD with an MRC dyspnoea scale score of 3 or more. 4a.2 Pulmonary rehabilitation is accessible to qualifying people with COPD. 4a.3 Pulmonary rehabilitation incorporates: • upper and lower body physical training, and • disease education including smoking cessation. 4a.4 - Pulmonary rehabilitation is available for people with COPD post exacerbation. Desirable criteria 4a.5 Pulmonary rehabilitation incorporates: • medication management • nutritional intervention • psychological and behavioural interventions, and • occupational therapy.

6. Running class at central PRI site with present staffing
Delivering class via Tanberg 880s Codec camera with 28 inch monitor to Pitlochry Community Hospital
Physiotherapy Assistant supporting and supervising patients at Pitlochry

7. Programme Ran Oct – Dec 2008 12 patients assessed for PRI
10 patients completed
122 attendances
3 patients assessed for Pitlochry
2 patients completed
34 attendances
Measures Reliability of Equipment Skill mix of staff Effectiveness of model Economics Satisfaction

8. Overview of Service
Referrals to Physiotherapy

9. CONFIRM DIAGNOSIS OF COPD
GUIDELINE FOR REFERRAL TO THE (PILOT)
TELEMEDICINE PULMONARY REHABILITATION FOR COPD
The principal goals of pulmonary rehabilitation are to reduce the symptoms, improve quality of life
and increase physical and emotional participation in everyday activities.
DRAFT
CONFIRM DIAGNOSIS OF COPD
YES
Moderate/Severe COPD
and/or
MRC 3 or above NO
Optimise drug therapy
Smoking cessation
Lifestyle advice
Exercise referral scheme
Refer to PRI Pulmonary Rehab Programme (if meets criteria)
Optimise Drug Therapy
Trial of long acting bronchodilator anticholinergic and reg B2-agonist
Ex-smoker/ motivated to stop
Willing to attend twice per week for 8 weeks
Able to get to Pilot Centre NO
YES
Any Contra-indications to rehab present?
Unstable angina
Unable to walk independently
Requires one-to-one input
Musculoskeletal problem causing ongoing stiffness or pain
Recent PE/DVT/MI (6 weeks)
2nd/3rd Degree heart block
Resting HR > 120
Resting BP systolic > 200/diastolic >100
Dementia/Psychosis
Hearing or Visual impairment (i.e. not able to follow instruction from monitor)
Requiring oxygen to safely exercise
MRC Dyspnoea scale
Grade
Degree of breathlessness related to activities
Not troubled by breathlessness except on strenuous exercise
Short of breath when hurrying or walking up a slight hill
Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
Stops for breath after walking about 100m or after a few minutes on level ground
Too breathless to leave the house, or breathless when dressing or undressing
YES 1 2 NO 3
REFER TO PULMONARY REHAB
Pilot Telemedicine Pulmonary Rehab
Physiotherapy Dept
Perth Royal Infirmary
Perth
PH1 1NX 4 5

10. Overview of Service
Format: 10 weeks x twice a week (currently testing 8)
8 weeks programme: 1 week either side for assessment pre and post
Content: Physical activity; graduated exercise programme
Education:
What is COPD
Breathing Control
Sputum Clearance
Medication and Inhalers
Nutrition
* Pensions and Benefits
Coping Strategies & Anxiety
Breathe Easy
Holidays & Travel
*Energy Consumption
*Equipment
*Time Management
*Relaxation
Keeping Active OT
Onward referral to Perth & Kinross Leisure
Pilot of Art Therapy

11. Where are we now? Where do we go from here?
Regular delivery to 3 outlying sites
Part of National project to further roll out
Testing 8 weeks programme
Up-skilling of CRT’s to deliver intervention
Where do we go from here?
Further efficiencies required
Need to expand access to incorporate exacerbations
Need to look at role of community teams/virtual wards

12. NEW DRIVERS Health of the Population Experience of Care Per Capita
QUALITY AMBITIONS
TRIPLE AIM
Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.
The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.
Health of the
Population
Experience
of Care
Per Capita
Cost

13. DISCUSSION