Quality assurance and control in pulmonary rehabilitation

Pulmonary rehabilitation (PR) is a highly effective, complex intervention for people suffering with COPD or other chronic respiratory diseases. PR variably comprises exercise therapy, disease education, behaviour change and psychological support. Recent guidelines provide a definition of PR, but the multicomponent character of the intervention renders the precise content and delivery of PR open to interpretation. Similarly, the experimental conditions characterizing randomized clinical trials may not apply in real-life clinical practice. There is a pressing need therefore for programmes to develop robust quality control and assurance processes to ensure services are delivered to adequate standards. Providing such evidence of the quality of service to patients, referrers and health policymakers will also assist the enhancement of referral rates and PR availability, which are known to be poor in many healthcare settings. In this chapter we consider measures that can be taken to ensure best practice, based on the most up-to-date scientific evidence is provided to patients in PR clinical practice and how PR programmes and policy makers can audit services to satisfy themselves (and their patient customers) that care is delivered to the highest standard/quality.