Caption: Barry Kehoe, Senior Physiotherapist and Claire Baily Scanlan, Clinical Specialist Physiotherapist, Respiratory Integrated Care Team, Chronic Disease Hub 3.

Community-based Pulmonary Rehabilitation (PR) is a service that has been running for three years in Dublin South West. It is run by physiotherapists from the Respiratory Integrated Care team in Chronic Disease Hub 3, who provide a PR service to those in their catchment area, as part of the Enhanced Community Care Programme.  It is an eight-week exercise and education programme delivered to patients with COPD and other lung conditions in a group session.  

PR is one of the most effective and efficient treatments for patients with chronic lung conditions. Before the COVID-19 pandemic, PR in the Dublin South West area took place in the exercise gym in the Russell Centre, Tallaght Cross West. However when the pandemic began, patients no longer had access to this vital programme. Patients with COPD were advised to stay at home and avoid social contact as much as possible, preventing them from accessing face-to-face PR sessions.

These COVID-19 restrictions encouraged the community-based PR staff in Dublin South West to explore other options for service delivery to their clients. Using the HSE approved platform ‘Attend Anywhere’ the staff were able to increase availability, adherence and engagement by offering ‘virtual pulmonary rehabilitation’ to COPD patients from the safety and comfort of their own homes.

Feedback from patients has been very positive including one patient who said “I didn’t feel alone”; another saying “I felt more confident and reassured”; and another saying “I have improved a great deal with moving in fact I am now capable of going upstairs without too much difficulty.”  Another said the programme helped their self-confidence, improved their stamina adding that  it also took the “fear factor out of my ability to push myself when exercising”.

According to Claire Baily Scanlon, Clinical Specialist Physiotherapist:  

“Although virtual PR will not replace traditional face-to-face PR, it will be helpful in the future to have this option for people who cannot travel to a gym for various reasons. It may also help in minimising the DNA rate. We will be better able to support patients who are confident with technology, possibly those who still work or those who are housebound or have transport issues.”

Claire added:  “Another area of expansion for the PR staff in Dublin South West was the provision of PR for patients post-COVID-19. The infrastructure of the PR programme combined with the experience of the staff and the availability of a reliable telehealth platform meant that our service was uniquely positioned to provide an adapted rehab approach to assist post-COVID-19 clients recover infection. Those discharged from hospital after treatment for COVID-19, and potentially those managed in the community are likely to report significant ongoing physical and functional impairment.

“There was a need to develop an appropriately targeted and safe rehabilitation programme to support the recovery of this population. The commonly reported symptoms of cough, breathlessness and fatigue are symptoms that can be managed within the existing PR programme.

“Our PR approach was well placed to deliver such a programme for this group. However, the broader recovery needs of the post-COVID-19 patient may well extend beyond the traditional boundaries of PR. Existing services will likely need to extend their scope of practice and collaborate with the wider multi-disciplinary team in order to ensure that these recovery needs are met in an adapted rehabilitation programme.   Virtual PR has been shown to be effective for a select group of patients who have both the equipment and technological literacy to engage in it. It will continue be a vital method to enable continued access and prevent service interruption in the future.”