Does pulmonary rehabilitation alter patients’ experiences of living with chronic respiratory disease? A qualitative study
Received 15 February 2018
Accepted for publication 26 April 2018
Published 8 August 2018 Volume 2018:13 Pages 2375—2385
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Rupert Jones,1 Herbert Muyinda,2 Grace Nyakoojo,2 Bruce Kirenga,2 Winceslaus Katagira,2 Jillian Pooler1
1Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK; 2Makerere University Lung Institute, College of Health Science, Makerere University, Kampala, Uganda
Purpose: Chronic respiratory disease (CRD) including COPD carries high and rising morbidity and mortality in Africa, but there are few available treatments. Pulmonary rehabilitation (PR) is a non-pharmacological treatment with proven benefits in improving symptoms and exercise capacity, which has not been tested in Africa. We aimed to evaluate the lived experience of people with CRD, including physical and psychosocial impacts, and how these are addressed by PR.
Patients and methods: A team of respiratory specialists, nurses, and physiotherapists implemented PR to meet the clinical and cultural setting. PR consisted of a 6-week, twice-weekly program of exercise and self-management education. Forty-two patients were recruited. Qualitative data were collected through interviews with patients at baseline and six weeks post-completion, focus group discussions, ethnographic observations, and brief interviews.
Results: Before and after PR, a total of 44 semi-structured interviews, 3 focus group discussions, and 4 ethnographic observations with brief interviews were conducted. Participants reported profound problems with respiratory symptoms, functional impairment, wide-reaching economic and psychological impacts, and social isolation. Patients who were debilitated by their condition before PR reported that PR addressed all their major concerns. It was reported that breathlessness, pain, immobility, weight loss, and other CRD-related symptoms were reduced, and social and intimate relationships were improved. Local materials were used to improvise the exercises, enabling some to be maintained at home. Recommendations for future PR programs included patient information to take home as a reminder of the exercises, and to show their families, and the support of a community health worker to help maintenance of exercises at home.
Conclusion: PR has the potential to restore the physical, mental, and social functioning in patients with CRD, whereas medication has much more narrow effects. PR offers a major new option for treatment of a neglected group of patients.
Keywords: exercise therapy, non-pharmacological treatment, self-management, stigma
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