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This learning resource forms part of a series: Pulmonary rehabilitation: How to prescribe individualised exercise programmes and activities.
The end of the pulmonary rehabilitation programme is an important time to assess how the programme has affected the symptoms and health of your patient, as well as providing your patient with appropriate resources to continue with their rehabilitation programme independently.
Discharge assessment
The discharge assessment is critical to understand the impact of the pulmonary rehabilitation programme on your patient’s overall health, functional status and quality of life. These assessments help to ensure that the programme has been effective, and when combined with assessments of other patients, provide insight which may help to determine how pulmonary rehabilitation is planned and performed within your service setting.
Much of the discharge assessment replicates the testing undertaken during the initial assessment before the programme began. These assessments should cover a range of measures of general and condition-specific health and objective assessments of exercise capacity and muscle strength, as well as reflecting on any individual goals set by the patient during the programme.
Minimally Clinically Important Difference (MCID)
The concept of Minimally Clinically Important Differences (MCIDS) is particularly useful to understand when reassessing patients during the discharge process.
In simple terms, the MCID is the smallest change in the scoring of an assessment that indicates a meaningful change for the patient. Pulmonary rehabilitation programmes should aim to achieve changes between initial and discharge assessment that are at (or above) MCID thresholds.
Not all assessments have validated MCID thresholds. You should be aware of the following MCID thresholds:
Supporting your patient to continue their rehabilitation independently
One of the final parts of the pulmonary rehabilitation programme is providing the patient with guidance on how to continue to exercise at home.
Your discharge assessment should provide you with a similar set of insights about the patient as your initial assessment, and you can use these insights to create a new individualised exercise programme for the patient to follow independently.
As with the programme you originally designed, you should base the patient’s independent exercise programme around the FITT-VP principles. Other important considerations include:
- Making sure the patient has a clear understanding of the signs of under and over-exertion to ensure they can exercise safely and effectively without clinical supervision.
- Designing a programme reflecting the patient’s access to exercise equipment and preferred types of exercise.
- For example, if you change the line height for the text in one “List Item,” you will want to make sure that you set the same line height for all other “List Items” so that they match.
- Explaining the general principles of exercise progression to allow the patient to adjust their own exercise programme as their exercise capacity and muscular strength improves over time.
Community exercise support
Outside of the exercise you directly programme for your patients, it is worth being aware of exercise options that are available in your local area that may support your patients to achieve their goals. For patients coming to the end of their pulmonary rehabilitation programme, providing recommendations about local exercise options may help them to stay active, maintain the benefits of the rehabilitation programme and benefit their long-term health.
These types of exercise programmes could include community groups, commercial gyms, activities organised by charities and local councils and a multitude of other options.
Many ideas for local activities can be found online, for example:
If your patient is able to be referred to a social prescriber (for example, through their GP), this may also be an option to help them access local exercise activities.
Note: very few community exercise programmes (supervised or directed classes delivered outside of a formal pulmonary rehabilitation programme) will include any element of clinical supervision. You should ensure that your patient is clear on how to safely exercise and the signs of over-exertion before recommending independent exercise programmes.
