British Thoracic Society Clinical Statement on pulmonary rehabilitation

IntroductIon The evidencebased British Thoracic Society (BTS) Guideline for pulmonary rehabilitation (PR) in adults was published in 2013. There is a strong evidence base for the benefits of PR, and it is one of the most costeffective interventions for adults with chronic obstructive pulmonary disease (COPD). Furthermore, PR improves exercise capacity and healthrelated quality of life (HRQOL) in COPD to a much greater magnitude than observed with bronchodilator therapy. Since the Guideline, there is deeper understanding of referral characteristics, outcome measures, patient selection, programme delivery, potential adjuncts and the role of maintenance following PR. The BTS Clinical Statement on PR is a narrative review which provides a snapshot of current knowledge and best practice in topical areas by providing a series of clinical practice points that are informed by evidence where this exists, or based on expert opinion and collective clinical experience where evidence is limited. The Clinical Statement is not intended to be a comprehensive review as much of the BTS Guideline remains relevant today and does not need revisiting. Furthermore, BTS, alongside other respiratory societies, reviewed the current state of education in PR. The intended audience are PR clinicians working within health settings in the UK and beyond. The Clinical Statement will provide a framework to inform future BTS Quality Standards for PR. We have also highlighted areas of research priority, which will be of interest to clinical researchers. In this Statement, we highlight the growing interest in alternative models of delivering PR (eg, home based, remote supervision, use of technology), accelerated by the restrictions placed on facetoface PR delivery during the global COVID19 pandemic. These PR models, typically delivered remotely, might potentially increase provision of, and accessibility to PR. However, research gaps remain and it is crucial these models are optimised and carefully evaluated before widespread adoption. A recent international workshop report, using a Delphi process, defined essential and desirable components of PR. We have adapted this to define the core components of PR (box 1), which will help health payers decide if they are commissioning an intervention that is likely to produce good outcomes. Methodology The Clinical Statement group (CSG) was chaired by SJS and WM and included experts in a range of disciplines including respiratory medicine, rehabilitation, physiotherapy and lay/patient input. The CSG identified key areas requiring clinical practice points and the overall content was developed to reflect the scope approved by the BTS Standards of Care Committee (SOCC). Following discussions of broad statement content, individual sections were drafted by group members. A final edited draft was reviewed by the BTS SOCC before posting for public BtS clinical Statement