COPD6 - The Effect of the Individual Practitioner

The effect of the individual practitioner in Pulmonary Rehabilitation - A report of the CoHoRT study of pulmonary rehabilitation.

JC Waterhouse1 SJ Walters2 RA Lawson1

Sheffield Teaching Hospitals NHS Trust 1 and School of Health and Related Research, University of Sheffield 2

In a recent UK Health Technology Assessment Board funded study to assess the effect of setting on the outcome of Pulmonary Rehabilitation, a standard programme has been given in hospital and community settings to people with COPD.. The programme was twice weekly for six weeks. Over the course of the study three teams were responsible for the programme, treating in both hospital and community. A team comprised an experienced Senior Physiotherapist and a Technical Instructor. All subjects received the same core education package. The three teams produced surprisingly different improvements.

Team	Mean distance pre rehab (±sd)	Mean distance post rehab (±sd)	% change post rehab (±sd)
Good (n=43)	287.2 (±136.0)	429.5 (±279.9)	69.5% (±116.4%)
Better (n=69)	288.4 (±148.3)	541.4 (±345.5)	91.6% (±125.2%)
Best (n=49)	260.7 (±126.0)	606.1 (±391.9)	139.8% (±155.2%)
Group total (n= 161)	279.7 (±138.3)	531.2 (±393.2)	100.3% (±134.9%)

P-value from one way ANOVA comparing mean outcomes across the three groups, p= 0.021 for absolute change in metres and 0.034 for % change relative to baseline.

We conclude that as yet undefined characteristics of staff are major modifiers of the success of pulmonary rehabilitation. This has important implications for recruitment and training, and for comparative analyses of existing research.

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