An International Comparison of Pulmonary Rehabilitation: A Systematic Review

BACKGROUND: Despite the strong evidence base, the perception remains that the provision of pulmonary rehabilitation (PR) services are extremely limited. Imbalances in PR delivery give rise to unnecessary health costs and underserviced populations. We conducted a systematic review to characterize the international provision of PR, comparing its structure and delivery across countries, and gaining insight into the availability of PR in relation to geographical prevalence. METHODS: Electronic databases were searched from inception to September 2013 using the key words "pulmonary rehabilitation" and "survey." Two authors independently reviewed studies and assessed study quality. Data was extracted and double-checked to ensure accuracy. RESULTS: The majority of programs (55-99%) were offered in an outpatient setting with the exception of Ireland, where the majority of programs were offered in the community (65%). Exercise was the primary component across all programs (77-100%), followed by education (74-100%). Physical therapists were the most common member of the PR team (49-100%). Functional walk tests were the most frequently used outcome measure, although the specific test utilized varied across countries. The current availability of PR services ≤1.2% of individuals with COPD. CONCLUSION: Components provided in PR are similar, irrespective of country, while patient outcome measures demonstrated variation across countries. Recent surveys report the use of community resources for the delivery of PR programs, although the majority are outpatient based. The small number of potential individuals enrolled in PR suggests that an international increase in access and capacity would improve quality of life and reduce healthcare utilization in this population.