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Rehabilitation for People with Respiratory Disease and Frailty: An Official American Thoracic Society Workshop Report

journal contribution
posted on 2023-06-30, 09:25 authored by Matthew Maddocks, Lisa J Brighton, Jennifer A Alison, Lies ter Beek, Surya P Bhatt, Nathan E Brummel, Chris Burtin, Matteo Cesari, Rachael A Evans, Lauren E Ferrante, Oscar Flores-Flores, Frits ME Franssen, Chris Garvey, Samantha L Harrison, Anand S Iyer, Lies Lahouse, Suzanne Lareau, Annemarie L Lee, William D-C Man, Alessandra Marengoni, Hamish JC McAuley, Dmitry Rozenberg, Jonathan P Singer, Martijn A Spruit, Christian R Osadnik

People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a “frailty rehabilitation paradox” whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.

History

Author affiliation

Department of Respiratory Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Annals of the American Thoracic Society

Volume

20

Issue

6

Pagination

767 - 780

Publisher

American Thoracic Society

issn

2329-6933

eissn

2325-6621

Copyright date

2023

Language

en

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