There is high quality evidence to support the benefits of pulmonary rehabilitation for people living with chronic respiratory disease. Why, then, do access and implementation remain poor? 

Pulmonary rehabilitation is a highly effective treatment but it could be argued that it is an implementation failure because so few people receive it across the globe. 

Some barriers are very difficult to address—for example, policy-related barriers regarding the value of rehabilitation and its remuneration; a lack of trained health professionals and pulmonary rehabilitation programs, particularly in low- and middle-income countries; and opaque or complex referral pathways. 

The ‘easier’ barriers to pulmonary rehabilitation access are the patient-related factors that limit attendance at traditional centre-based programs such as disability, travel and transport. 

These barriers can be addressed by taking pulmonary rehabilitation to the patient, which is where novel models of pulmonary rehabilitation come in. 

What are some novel models of care that have been developed and shown to better meet patient needs? 

Professor Anee Holland's oration at APASC25 will focus on pulmonary rehabilitation research.

A variety of remotely delivered pulmonary rehabilitation models have now been tested in clinical trials. 

Some are relatively simple (eg, telephone support for personalised goal setting and exercise coaching) and others involve more technology (eg, real-time supervision of exercise training via remote monitoring). 

All these models seem to deliver results that are similar to centrebased pulmonary rehabilitation. 

Where they differ is in completion rates, which are better for remotely delivered pulmonary rehabilitation. 

People who complete a program are much less likely to be admitted to hospital in the following year so this is important for both patients and the health system. 

What other models of care could be explored? 

As technology evolves, we will continue to see the emergence of new models of remote pulmonary rehabilitation. 

The question now is whether they can truly increase the number of people who complete a pulmonary rehabilitation program. 

If we can grow real-world implementation, then we will be making progress. 

As remote delivery models are made available to patients, quality assurance becomes even more critical. 

We know the essential components of pulmonary rehabilitation that drive its success (particularly whole-body exercise training that is individually prescribed and progressed). 

We must ensure that any new model that is offered to patients is not a poor quality substitute. 

>> Professor Anne Holland APAM is Professor of Physiotherapy and Head of Respiratory Research at Monash University and Alfred Health in Melbourne. Anne’s research program investigates supportive therapies for people with chronic respiratory disease, with a focus on chronic obstructive pulmonary disease and pulmonary fibrosis. 

>> Anne will present the Journal of Physiotherapy Rob Herbert Oration, ‘Enhancing access to best practice physiotherapy care—progress in pulmonary rehabilitation’, on Saturday 25 October at 8.30 am.

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