ABSTRACT
Current pulmonary rehabilitation (PR) guidelines recommend using self-management approaches to support behaviour change and improve the patient's ability to self-manage their disease on a day-to-day basis during PR so it can be used until long after the programme is completed. Evidence around chronic obstructive pulmonary disease (COPD) self-management interventions has been building up over the last two decades.
Besides physical activity, for which effective approaches to maintain gains after the end of PR programmes are still lacking, there are many other behaviours to consider such as improving adherence to medication, recognizing exacerbation and acting properly on it (e.g. using COPD exacerbation action plans), changing nutritional habits, breathing regulation techniques, and applying energy-saving strategies during activities of daily living. The precise content of the self-management intervention will depend on the severity and complications (recurrent exacerbations), the presence of comorbidity and patients’ own capacity to manage their disease.
Having an assigned case manager can facilitate communication with the team's other health professionals to ensure regular progress and problem assessments, common goal setting, motivation and confidence building, and problem-solving support. The role of case managers and the quality assurance in clinical practice need more consideration.
We have to take the next steps of redefining education and including self-management approaches in PR through enhanced assessment of patients, tailoring educational and self-management activities, and evaluating their impact on learning and behaviour changes, to advance PR for the future.
