0
Correspondence |

Acute Exacerbations of COPDPhysiotherapy in Acute Exacerbations: Will On-Call Physiotherapy Allow for Early Rehabilitation? FREE TO VIEW

Abraham Samuel Babu, MPT
Author and Funding Information

From the Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University.

Correspondence to: Abraham Samuel Babu, MPT, Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University, Manipal, 576104, Karnataka, India; e-mail: abrahambabu@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):280-281. doi:10.1378/chest.12-2225
Text Size: A A A
Published online
To the Editor:

Pulmonary rehabilitation has gained prominence and support from a growing body of evidence over the last 15 years. Goldstein et al1 elucidated in CHEST (September 2012) the benefits of pulmonary rehabilitation and highlighted the available literature. They wonderfully synthesized the available evidence and also elaborated on key areas that require further research.

Acute exacerbations of COPD cause severe functional limitations and greatly affect the functional state of the patient. The use of early mobilization and chest physiotherapy interventions were earlier considered absolute contraindications. However, in the last 2 years, research has begun to focus on the benefits of early mobilization and exercises during an acute exacerbation. Despite this interest, only limited studies have focused on exercise interventions and chest physiotherapy during the acute exacerbation.2,3

A recent clinical trial by Tang et al2 evaluated the use of 15-min bid exercise sessions (aerobic and resistance) at low and moderate to high intensities along with chest physiotherapy from the second day of admission until discharge. Improvements in 3-min walk test results favored the low-intensity exercise group even though both intensities produced changes in distances between 21 and 31 m (P < .05).

The evaluation of physiotherapy interventions (ie, bronchial hygiene therapy and positioning) through on-call services was evaluated in a small study from a rural center in India from the time of admission until discharge.3 Gradual mobilization and walking was initiated once the patient was in the ward. The study found greater improvements in 6-min walk distance at discharge among those who received on-call physiotherapy services and early mobilization (387.89±110.1 m) compared with those who received only regular physiotherapy services (289.73±103.2 m) (P < .05).3

On-call physiotherapy began gaining popularity in the 1980s and is defined as “the provision of respiratory/cardiorespiratory/cardiothoracic or combinations of respiratory and orthopaedic physiotherapy, out of working hours.”4 On-call physiotherapy services require physiotherapists trained in emergency respiratory care, along with administrative support to provide around-the-clock services for patients with respiratory problems.5 Whether this will promote a faster initiation of pulmonary rehabilitation programs leading to improved outcomes remains to be seen. Current literature suggests benefits with chest physiotherapy and early mobilization during acute exacerbations of COPD. The clinical benefits vs the administrative requirements and training for on-call physiotherapy services will need to be weighed against the clinical benefits for patients with acute exacerbations of COPD.

References

Goldstein RS, Hill K, Brooks D, Dolmage TE. Pulmonary rehabilitation: a review of the recent literature. Chest. 2012;142(3):738-749. [CrossRef] [PubMed]
 
Tang CY, Blackstock FC, Clarence M, Taylor NF. Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2012;32(3):163-169. [PubMed]
 
Babu AS, Noone MS, Haneef M, Samuel P. The effects of ‘on-call/out of hours’ physical therapy in acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Clin Rehabil. 2010;24(9):802-809. [CrossRef] [PubMed]
 
Gough S, Doherty J. Emergency on-call duty preparation and education for newly qualified physiotherapists: a national survey. Physiotherapy. 2007;93(1):37-44. [CrossRef]
 
Babu AS. On-call physiotherapy–where are we and what lies ahead?. J Nov Physiother. 2012;2:e123. [CrossRef]
 

Figures

Tables

References

Goldstein RS, Hill K, Brooks D, Dolmage TE. Pulmonary rehabilitation: a review of the recent literature. Chest. 2012;142(3):738-749. [CrossRef] [PubMed]
 
Tang CY, Blackstock FC, Clarence M, Taylor NF. Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2012;32(3):163-169. [PubMed]
 
Babu AS, Noone MS, Haneef M, Samuel P. The effects of ‘on-call/out of hours’ physical therapy in acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Clin Rehabil. 2010;24(9):802-809. [CrossRef] [PubMed]
 
Gough S, Doherty J. Emergency on-call duty preparation and education for newly qualified physiotherapists: a national survey. Physiotherapy. 2007;93(1):37-44. [CrossRef]
 
Babu AS. On-call physiotherapy–where are we and what lies ahead?. J Nov Physiother. 2012;2:e123. [CrossRef]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543