Knowledge, confidence, and clinical experience of physiotherapists and multiprofessional team on pulmonary rehabilitation
DOI:
https://doi.org/10.1590/1809-2950/e23007724ptKeywords:
Lung diseases, Chronic Obstructive Pulmonary Disease, Rehabilitation, Physical Therapists, Health Care ProfessionalAbstract
The knowledge deficit of health professionals has been
a barrier to expanding and implementing pulmonary rehabilitation
(PR) services, despite its reported benefits for individuals with
chronic respiratory disease (CRD). This survey is part of a larger
project to implement PR in the Brazilian public health system,
by assessing the preparedness of health care professionals from two
Brazilian cities to perform it. A self-administered questionnaire was
used to assess the knowledge (19 questions), training (7 questions),
confidence (10 questions), and clinical experience (8 questions)
of physical therapists (PT) and the multiprofessional team (MT)
before a PR workshop. In total, 44 PT and 231 MT answered the
questionnaire. The mean total knowledge score was 10±3 for PT
and 6±3 for MT. Few physical therapist reported having “a lot” of
experience (25%) and confidence (22.7%) to perform PR, as well as
sufficient training to conduct the six-minute walk test (27.3%).Even
fewer MT reported having “a lot” of experience (10%) and sufficient
training (4.8%) to perform PR, as well as to plan the educational
program for patients (10%) and the confidence to refer patients to
PR (6.5%). This is the first study to evaluate the preparedness of
professionals from the Brazilian public health network to provide
PR. Notably, both PT and MT have low preparation to perform PR
in the studied cities, reinforcing the need for continuing education.
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References
World Health Organization. Chronic respiratory diseases
(asthma, COPD). Geneva: WHO; [2022] [cited Mar 13,
. Available from: https://www.who.int/westernpacific/
health-topics/chronic-respiratory-diseases
Adeloye D, Chua S, Lee C, Basquil C, Papana A, et al. Global
and regional estimates of COPD prevalence: Systematic
review and meta-analysis. J Glob Health. 2015;5(2):020415.
doi: 10.7189/jogh.05.020415
Global Initiative for Chronic Obstructive Lung Disease. Global
Strategy for the Diagnosis, Management, and Prevention
of Chronic Obstructive Pulmonary Disease (2020 Report).
Fontana: GOLD; 2020 [cited Sept 23, 2021]. Available from:
https://goldcopd.org/wp-content/uploads/2019/12/GOLD2020-FINAL-ver1.2-03Dec19_WMV.pdf
Naghavi M, Wang H, Lozano R, Davis A, Ling X, et al.
Global, regional, and national age-sex specific all-cause
and cause-specific mortality for 240 causes of death, 1990-
: A systematic analysis for the Global Burden of Disease
Study 2013. Lancet. 2015;385(9963):117-71. doi: 10.1016/
S0140-6736(14)61682-2
Moreira GL, Manzano BM, Gazzotti MR, Nascimento OA, PerezPadilha R, et al. PLATINO, estudo de seguimento de nove
anos sobre DPOC na cidade de São Paulo: O problema do
subdiagnóstico. J Bras Pneumol. 2014;40(1):30-7. doi: 10.1590/
S1806-37132014000100005
Brasil. Ministério da Saúde . DATASUS. Morbidade Hospitalar do
SUS - por local de internação - Brasil. Brasília, DF; c2003-2021
[cited May 3, 2021]. Available from: http://tabnet.datasus.gov.
br/cgi/tabcgi.exe?sih/cnv/niuf.def
Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, et al.
An official American Thoracic Society/European Respiratory
Society policy statement: Enhancing implementation, use, and
delivery of pulmonary rehabilitation. Am J Respir Crit Care
Med. 2015;192(11):1373-86. doi: 10.1164/rccm.201510-1966ST
Singh SJ, Zuwallack RL, Garvey C, Spruit MA, Task on behalf
of the ATSRS, Rehabilitation force on pulmonary. Learn from the past and create the future: the 2013 ATS/ERS statement
on pulmonary rehabilitation. Eur Respir J. 2013;42:1169-74.
doi: 10.1183/09031936.00207912
Spruit MA, Pitta F, Garvey C, ZuWallack RL, Roberts CM, et al.
Differences in content and organisational aspects of pulmonary
rehabilitation programmes. Eur Respir J. 2014;43(5):1326-37.
doi: 10.1183/09031936.00145613
Barreto GZ, Ivanaga IT, Chiavegato L, Gazzotti MR,
Nascimento OA, et al. Perspective of Pulmonary Rehabilitation
Centers in Latin America. COPD. 2021;18(4):401-5.
doi: 10.1080/15412555.2021.1934822
Yohannes AM, Connolly MJ. Pulmonary rehabilitation
programmes in the UK: A national representative survey. Clin
Rehabil. 2004;18(4):444-9. doi: 10.1191/0269215504cr736oa
Brook D, Sottana R, Bell B, Hanna M, Laframboise L, et al.
Characterization of pulmonary rehabilitation programs
in Canada in 2005. Can Respir J. 2007;14(2):87-92.
doi: 10.1155/2007/951498
White P, Gilworth G, Lewin S, et al. Improving uptake and
completion of pulmonary rehabilitation in COPD with lay health
workers: Feasibility of a clinical trial. Int J Chron Obstruct
Pulmon Dis. 2019;14:631-43. doi: 10.2147/COPD.S188731
Johnston KN, Young M, Grimmer KA, Antic R, Frith PA. Barriers
to, and facilitators for referral to pulmonary rehabilitation in
COPD patients from the perspective of Australian general
practitioners : a qualitative study. Prim Care Respir J.
;22(3):319-24. doi: 10.4104/pcrj.2013.00062
Keating A, Lee AL, Holland AE. Lack of perceived benefit and
inadequate transport influence uptake and completion of
pulmonary rehabilitation in people with chronic obstructive
pulmonary disease: a qualitative study. J Physiother.
;57(3):183-90. doi: 10.1016/S1836-9553(11)70040-6
Johnston CL, Maxwell LJ, Maguire GP, Alison JA. How
prepared are rural and remote health care practitioners
to provide evidence-based management for people with
chronic lung disease? Aust J Rural Health. 2012;20(4):200-7.
doi: 10.1111/j.1440-1584.2012.01288.x
Swift E, O’Brien MR, Peters S, Kelly C. Healthcare professionals’
perceptions of pulmonary rehabilitation as a management
strategy for patients with chronic obstructive pulmonary
disease: a critical interpretive synthesis. Disabil Rehabil.
;44(4):520-35. doi: 10.1080/09638288.2020.1769745
Chen YJ, Fan JY, Guo SE, Hwang SL, Yang TM. Factors facilitating
and hindering the intention to promote pulmonary rehabilitation
for patients with COPD among respiratory therapists. Int J
Chron Obstruct Pulmon Dis. 2017;12:2695-702. doi: 10.2147/
COPD.S142124
Dean AG, Sullivan KM, Soe MM, Mir RA, editors. OpenEpi: Open
Source Epidemiologic Statistics for Public Health [Internet].
[place unknown]; 2013 [cited Sept 17, 2021]. Available from:
https://www.openepi.com/Menu/OE_Menu.htm
Clini E, Holland A, Pitta, F, Troosters T. Textbook of Pulmonary
Rehabilitation. Amsterdam: Springer International Publishing;
doi: 10.1007/978-3-319-65888-9
Garrod R, Lasserson T. Role of physiotherapy in the management
of chronic lung diseases: An overview of systematic
reviews. Respir Med. 2007;101(12):2429-36. doi: 10.1016/j.
rmed.2007.06.007
Johnston CL, Maxwell LJ, Alison JA. Pulmonary rehabilitation in
Australia: A national survey. Physiotherapy. 2011;97(4):284-90.
doi: 10.1016/j.physio.2010.12.001
Kocks JWH, Asijee GM, Tsiligianni IG, Kerstjens HAM, van der
Molen T. Functional status measurement in COPD: a review of
available methods and their feasibility in primary care. Prim
Care Respir J. 2011;20(3):269-75. doi: 10.4104/pcrj.2011.00031
Yawn BP, Mintz ML, Doherty DE. GOLD in Practice : Chronic
Obstructive Pulmonary Disease Treatment and Management
in the Primary Care Setting. Int J Chron Obstruct Pulmon Dis.
;16:289-99. doi: 10.2147/COPD.S222664
Zainuldin R, Mackey MG, Alison JA. Prescription of walking
exercise intensity from the 6-minute walk test in people with
chronic obstructive pulmonary disease. J Cardiopulm Rehabil
Prev. 2015;35(1):65-9. doi: 10.1097/HCR.0000000000000074
Huang LH, Chen YJ. The 6-minute walk test to assess exercise
capacity of patients with chronic obstructive pulmonary
disease. Eur Respir J. 2016;48(suppl 60). doi: 10.1183/13993003
Summers RH, Ballinger C, Nikoletou D, Garrod R, Bruton
A, Leontowitsch M. Giving hope, ticking boxes or securing
services? A qualitative study of respiratory physiotherapists’
views on goal-setting with people with chronic obstructive
pulmonary disease. Clin Rehabil. 2017;31(7):978-91.
doi: 10.1177/0269215516658937
Ke X, Marvel J, Yu TC, Wertz D, Geremakis C, et al. Impact of
lung function on exacerbations, health care utilization, and
costs among patients with COPD. Int J Chron Obstruct Pulmon
Dis. 2016;11(1):1689-703. doi: 10.2147/COPD.S108967
Özmen İ, Yıldırım E, Öztürk M, Ocakli B, Yildiz R, et al. Pulmonary
rehabilitation reduces emergency admission and hospitalization
rates of patients with chronic respiratory diseases. Turkish
Thorac J. 2018;19(4):170-5. doi: 10.5152/TurkThoracJ.2018.17089
Johnston CL, Maxwell LJ, Maguire GP, Alison JA. Does delivery
of a training program for healthcare professionals increase
access to pulmonary rehabilitation and improve outcomes for
people with chronic lung disease in rural and remote Australia?
Aust Heal Rev. 2014;38(4):387-95. doi: 10.1071/AH14009
Janssens W, Corhay JL, Bogaerts P, et al. How resources
determine pulmonary rehabilitation programs: A survey
among Belgian chest physicians. Chron Respir Dis. 2018;16.
doi: 10.1177/1479972318767732
Johnston CL, Maxwell LJ, Alison JA. Establishing and delivering
pulmonary rehabilitation in rural and remote settings: The
opinions, attitudes and concerns of health care professionals.
Aust J Rural Health. 2015;24(2):106-14. doi: 10.1111/ajr.12202
Bickton FM, Shannon H. Barriers and Enablers to Pulmonary
Rehabilitation in Low-and Middle-Income Countries: A Qualitative
Study of Healthcare Professionals. Int J Chron Obstruct Pulman
Dis. 2022;17:141-53. doi: 10.2147/COPD.S348663.
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