Vreeken HL1, Beekman E2, Post MHT3, van 't Hul AJ4, Meerhoff GA1, Spruit MA5,6,7
1Royal Dutch Society for Physical Therapy (KNGF), Quality Policy, Amersfoort, Netherlands, 2Zuyd University of Applied Sciences, Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Heerlen, Netherlands, 3Dutch Society of Exercise Therapists Cesar and Mensendieck (VvOCM), Utrecht, Netherlands, 4UMC St Radboud, Department of Pulmonary Diseases, Nijmegen, Netherlands, 5CIRO, Center of Expertise for Chronic Organ Failure, Horn, Netherlands, 6Maastricht University Medical Centre - Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands, 7REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences and Physiotherapy, Diepenbeek, Belgium
Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality globally. Despite optimal medical therapy, patients with COPD still suffer from ventilatory limitations, impaired mucus clearance, and lower-limb and respiratory muscle dysfunction, which contribute to disabilities in daily activities. Physical therapy (PT) relieves symptoms (e.g. dyspnoea, fatigue, anxiety and depression), improves physical function (exercise capacity and physical activity) and quality of life, and reduces (re-)hospitalization rates. Although the effectiveness of PT for COPD in general is undisputed, specific aspects of PT remain unclear in the current Dutch COPD guideline from 2008. For example, diagnostics and therapy in specific patient groups are not addressed, including hospitalized patients; recommendations on the content and form of PT are insufficient; and new PT modalities that have been developed in the past decade are not included.
Purpose: To promote high-quality care in patients with COPD the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Society of Exercise Therapists Cesar and Mensendieck (VvOCM) develop a new, easy-to-use guideline which offers practical, specific and up-to-date recommendations for PT.
Methods: A new PT guideline for patients with COPD is being developed. Clinical questions on diagnostics, therapy and organisation of care were formulated based on a comprehensive problem analysis including six focus group discussions with physical therapists, exercise therapists, patients and other relevant healthcare professionals and stakeholders. Peer-reviewed scientific evidence was systematically reviewed and rated according to the GRADE methodology, if appropriate. A multidisciplinary guideline panel weighted all pros and cons and formulated practical recommendations taking into account the scientific evidence, patients' values and preferences, and professional expertise. Finally, an external review of the concept guideline will be conducted followed by authorisation by all relevant healthcare professions and stakeholders.
Results: This COPD guideline will focus on three PT key areas: exercise capacity, physical activity and the respiratory system. To select the right treatment, for the right patient at the right location, the guideline will introduce a new indication and classification model for PT based on four clinically relevant patient characteristics: state of COPD (stable/exacerbation), degree of symptom burden, physical capacity and physical activity. It will provide applicable recommendations for all settings (i.e. PT in primary care, hospital-based, and as part of a pulmonary rehabilitation program), for specific patient groups (comorbidity, exacerbation, hospitalised, palliative stage) as well as specifications on the content and form of therapy (e.g. intensity, type, modality or use of supporting devices). Key recommendations will be presented for the first time at the WCPT conference.
Conclusion(s): A new PT guideline for COPD is developed that contains specific and practical recommendations, particularly aimed at increasing physical capacity, promoting physical activity and supporting the respiratory system.
Implications: The guideline facilitates provision of high-quality PT care for patients with COPD. It assists physical therapists with clinical decisions about appropriate diagnostic and therapeutic procedures, increases the quality of care and reduces variation in services, procedures and outcomes of care for patients with COPD. Accompanying products will be developed to enhance implementation, e.g. e-learning, training, patient information, factsheets and indicators.
Keywords: COPD, Evidence-based medicine, Guideline
Funding acknowledgements: Funding: the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Association of Exercise Therapists Cesar and Mensendieck (VvOCM).
Purpose: To promote high-quality care in patients with COPD the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Society of Exercise Therapists Cesar and Mensendieck (VvOCM) develop a new, easy-to-use guideline which offers practical, specific and up-to-date recommendations for PT.
Methods: A new PT guideline for patients with COPD is being developed. Clinical questions on diagnostics, therapy and organisation of care were formulated based on a comprehensive problem analysis including six focus group discussions with physical therapists, exercise therapists, patients and other relevant healthcare professionals and stakeholders. Peer-reviewed scientific evidence was systematically reviewed and rated according to the GRADE methodology, if appropriate. A multidisciplinary guideline panel weighted all pros and cons and formulated practical recommendations taking into account the scientific evidence, patients' values and preferences, and professional expertise. Finally, an external review of the concept guideline will be conducted followed by authorisation by all relevant healthcare professions and stakeholders.
Results: This COPD guideline will focus on three PT key areas: exercise capacity, physical activity and the respiratory system. To select the right treatment, for the right patient at the right location, the guideline will introduce a new indication and classification model for PT based on four clinically relevant patient characteristics: state of COPD (stable/exacerbation), degree of symptom burden, physical capacity and physical activity. It will provide applicable recommendations for all settings (i.e. PT in primary care, hospital-based, and as part of a pulmonary rehabilitation program), for specific patient groups (comorbidity, exacerbation, hospitalised, palliative stage) as well as specifications on the content and form of therapy (e.g. intensity, type, modality or use of supporting devices). Key recommendations will be presented for the first time at the WCPT conference.
Conclusion(s): A new PT guideline for COPD is developed that contains specific and practical recommendations, particularly aimed at increasing physical capacity, promoting physical activity and supporting the respiratory system.
Implications: The guideline facilitates provision of high-quality PT care for patients with COPD. It assists physical therapists with clinical decisions about appropriate diagnostic and therapeutic procedures, increases the quality of care and reduces variation in services, procedures and outcomes of care for patients with COPD. Accompanying products will be developed to enhance implementation, e.g. e-learning, training, patient information, factsheets and indicators.
Keywords: COPD, Evidence-based medicine, Guideline
Funding acknowledgements: Funding: the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Association of Exercise Therapists Cesar and Mensendieck (VvOCM).
Topic: Cardiorespiratory; Research methodology & knowledge translation; Professional practice: other
Ethics approval required: No
Institution: not applicable
Ethics committee: not applicable
Reason not required: The guideline development project did not involve medical-scientific research with people.
All authors, affiliations and abstracts have been published as submitted.
