Study identifies strategies for rapid access rehab program success post-COPD hospitalization

A new study published in Respiratory Medicine identified approaches for success in establishing a rapid access rehabilitation program following hospitalization for acute exacerbations of COPD.

“Considering the demonstrated benefits of early post-acute exacerbation of COPD rehabilitation and the limited access to conventional programs, there is increasing interest in the provision of a rapid access rehabilitation program,” Ana Oliveira, PhD, researcher at the School of Rehabilitation Science at McMaster University, Hamilton, and West Park Healthcare Centre, Toronto, and the Respiratory Research and Rehabilitation Laboratory in the School of Health Sciences and the Institute of Biomedicine at the University of Aveiro in Portugal, and colleagues wrote. “The rapid access rehabilitation program accepts patients within 48 hours of their discharge from hospital to provide a bridge from the peri-exacerbation period to enrollment in a conventional pulmonary rehabilitation program.”

Researchers conducted semi-structured interviews using phone calls with three patients recently hospitalized for acute exacerbations of COPD, 10 health care professionals and three policymakers who provided care for these patients from September to December 2020.

All of those interviewed shared similar visions for the essential elements and approaches of a rapid access rehabilitation program, according to the researchers. The interviews led to the following themes for the development of a rapid access rehabilitation program:

• pre-rapid access rehabilitation aspects (management properties, eligibility);
• rapid access rehabilitation program (outcomes, structure, components);
• rapid access rehabilitation optimization (referral, uptake);
• partnership (collaboration, dedicated coordinator); and
• COVID-19 adaptations.

In addition, patients, health care professionals and policymakers identified the following as essential elements for developing a program for this population: clear eligibility criteria, addressing patients’ needs at discharge, having structured education and self-management programs and modifying to respond to unexpected events.

“There is ongoing interest in better understanding the role of post-acute exacerbation of COPD pulmonary rehabilitation and there does appear to be a consistent need for programs that are flexible to patient needs and that emphasize self-management,” the researchers wrote.

For rapid access rehabilitation referral optimization, participants suggested a clear referral pathway, improving program awareness, assigning dedicated care coordinators to provide patient support, and establishing strong partnerships with different care settings and providers. One way to accomplish these tasks would be to make rapid access rehabilitation part of standard care and follow similar models from other rehabilitation areas, according to the researchers.

“A structured program based on education and self-management customized to patients needs and adaptable to unexpected events such as COVID were considered essential components of rapid access rehabilitation development,” the researchers wrote. “Suggestions for optimizing referral, uptake and effectiveness include raising program awareness, having a clear referral pathway, a dedicated care coordinator and established partnership among different care settings and providers.”

Currently, a Delphi study based on these results is being created to include a broader and international participant range to define final characteristics of a rapid access rehabilitation programs after hospital discharge, according to the researchers.