The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review

BACKGROUND

Chronic respiratory diseases are highly prevalent and compromise an individual's ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual's exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful "occupations," improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines.

OBJECTIVE

The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs.

METHODS

The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic.

RESULTS

The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022.

CONCLUSIONS

The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes.

TRIAL REGISTRATION

OSF Registries ZH63W; https://osf.io/zh63w.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30244.

Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

Purpose

It is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.

Patients and methods

We retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.

Results

Seventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH₂O vs −43.25 cmH₂O, P<0.01; −34.67 cmH₂O vs −48.18 cmH₂O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH₂O vs 46.05 cmH₂O, P<0.01; 37.78 cmH₂O vs 45.72 cmH₂O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV₁; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF_25–75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV₁ (96 L vs 1.09 L, P<0.05) and FEF_25–75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF_25–75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.

Conclusion

PRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF_25–75 in COPD patients.