M. van Doormaal1, H. Vreeken1, E. Beekman2,3, M. Spruit4,5, G. Meerhoff1,6
1Royal Dutch Society for Physical Therapy, Quality, Amersfoort, Netherlands, 2Zuyd University of Applied Sciences, Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Heerlen, Netherlands, 3Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands, 4CIRO+, Department of Research and Development, Horn, Netherlands, 5Maastricht University Medical Center (MUMC+), Department of Respiratory Medicine, Maastricht, Netherlands, 6Radboudumc, Institute for Quality in Health Care (IQ Healthcare), Nijmegen, Netherlands

Background: It is widely accepted that physical therapy (PT) plays an important role in improving or maintaining health status in patients with COP. A clinical practice guideline is important to deliver optimal treatment by physical therapists. However, the 2008 guideline from the Royal Dutch Society for Physical Therapy (KNGF) was outdated regarding the latest scientific developments and recommendations in this guideline did not differentiate between patients. Therefore, a revised guideline was necessary to support physical therapists in making clinical decisions for a wide variety of patients with COPD.

Purpose: To revise the KNGF-guideline COPD with up to date recommendations for patients with different characteristics and in different stages of the disease.

Methods: International standards for guideline development (GRADE, AGREE II and G-I-N) were followed to develop the revised guideline. In 2018, a guideline panel with representatives of relevant stakeholders (for example physical therapists, a pulmonologist, a general practitioner and patients) was composed and clinical questions were formulated based on perceived barriers in daily practice. For each clinical question, literature was reviewed and considerations were described according to the GRADE evidence to decision framework in order to formulate recommendations. The concept guideline was reviewed before publication by a large panel of physical therapists and different representing organizations of relevant stakeholders.

Results: Based on the perceived barriers, the guideline panel formulated 34 clinical questions. All these questions were answered with one or more recommendations, resulting in a clinical practice guideline. The most important recommendation in this guideline included the use of a flow chart to stratify patients in six profiles based on the burden of disease, physical capacity (PC) and physical activity (PA). Patients in profile 1 and 2 (low disease burden or sufficient PC and PA) do not need treatment from a physical therapist, while patients in profile 3, 4 and 5 (mild to moderate disease burden and insufficient PC and/or PA) should be treated in primary care. Screening for interdisciplinary pulmonary rehabilitation is necessary for patients in profile 6 (high disease burden or after hospitalization). For patients in profile 3 to 6, the most adequate PT care was described and a recommendation was formulated for which patients cardiopulmonary exercise testing is needed. Moreover, the guideline included recommendations on the adjustment of the PT treatment in patients with comorbidity, after an exacerbation or in the palliative stage of the disease.  

Conclusion(s): The new KNGF-guideline COPD was published in July 2020 and supports physical therapists in making decisions regarding the treatment of a wide variety of patients with COPD.

Implications: To improve quality of care, adherence to the guideline is important. Implementation strategies included educational meetings, online training, a summary handout with the key recommendations, publications in PT journals and patient information. Moreover, further improvement of the reimbursement is necessary to provide all patients the most adequate PT treatment.

Funding, acknowledgements: Royal Dutch Society for Physical Therapy

Keywords: COPD, Guideline, Stratification

Topic: Cardiorespiratory

Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Clinical Practice Guideline

All authors, affiliations and abstracts have been published as submitted.

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