Evaluation of a novel pulmonary rehabilitation programme in Newport, South Wales

Background: Access to pulmonary rehabilitation (PR) is patchy in the UK. Half of those eligible are offered the service and waiting times may be long (National UK COPD Audit 2008). In 2012 the waiting list for Newport PR was 6 months. Doubling capacity was needed to meet demand. Methods: We introduced a novel 9back to back9 (b2B) programme where two PR groups exercised, one either side of the education session, effectively doubling capacity of the PR service at nominal cost. The service evaluation compared the single cohort results 2012-3 with the back to back results 2013-14. The educational material, programme structure and staff were the same throughout. Results: Between 2012-14 a total of 369 patients took part in pulmonary rehabilitation (b2B 223, 146 Single). The single and b2B cohorts were matched at baseline in terms of six minute walk times (6MWT), CAT score, CRQ and HAD scores. The respiratory disease case mix and drop out rates were similar. There were no adverse events in Single or b2B cohorts. The mean 6MWT in b2B increased from 192m to 291m compared to 154m and 210m in the single cohorts (NS). The CRQ increased by 0.95 in b2B (0.56 in Single) (p=0.04). CAT decreased by more than the Minimal Clinically Important Difference (MCID) in both cohorts but the HAD score decreased by the MCID in only the b2B cohorts. Conclusion: The b2B pulmonary rehabilitation programme doubled PR capacity in Newport at nominal extra cost. There was no sign that doubling the size of the group for the education component compromised quality or safety. Quality of life outcome measures may be improved by the b2B programme possibly as a result of enhanced community and self-help in a larger group.