Current Perspectives and Future Directions of Repeat Pulmonary Rehabilitation Programmes in People with Chronic Obstructive Pulmonary Disease: A Narrative Review of the Literature

Abstract

The benefits of pulmonary rehabilitation (PR) diminish over 12–24 months following programme completion. A repeat PR programme may potentially prevent or reverse this decline in gains and may provide additional benefits. The aim of this narrative review was to discuss the current available evidence regarding repeat PR programmes and provide perspectives on unresolved questions, future areas of inquiry, and suggestions for clinical practice. Randomised controlled trials showed PR repeated at 6, 12, or 24 months after the initial PR programme resulted in similar short-term improvements in exercise capacity and quality of life; however, they did not result in long-term benefits beyond 12–24 months. In uncontrolled studies, the improvements in exercise capacity achieved following repeat PR were of a smaller magnitude than after the initial PR programme, but the improvements were still clinically significant. There is limited evidence to guide the optimal timing and characteristics of a repeat PR programme, such as frequency, duration and content, as well as which patients may benefit. There are ethical factors to consider in offering repeat PR programmes, including availability and access, the impact on resources and capacity of PR programmes, and patient-related factors such as financial burden and difficulties with transport. Alternate means of delivering a repeat PR programme should be explored, especially with emerging evidence for home-based PR and telerehabilitation programmes. A modular approach to a repeat PR programme by offering only certain elements rather than a comprehensive programme may also address the aspects of access, resources, capacity, and patient burden.