Physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease

This thesis investigated the role of chest physiotherapy for patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and examined the level of safety and feasibility of implementing an early exercise program for inpatients during an AECOPD. A systematic review of the safety and effectiveness of various chest physiotherapy techniques found little evidence that chest physiotherapy techniques were beneficial to inpatients during an AECOPD. Walking programs were the only intervention that had moderate level of evidence supporting effectiveness in improving exercise capacity and gaseous exchange. In addition, quadriceps strengthening has also been found to be effective in improving muscle strength and exercise capacity in patients with an AECOPD. These results suggested the possibility of testing a program based on the exercise component of pulmonary rehabilitation, combining strengthening and aerobic training for patients admitted to hospital with an AECOPD. To evaluate the safety and feasibility of an exercise program, a randomised controlled trial was conducted and provided evidence that the program was safe with high completion rates across all groups. A significant improvement in three minute walk test in both exercise groups and small non-significant effect sizes favouring exercise groups over control group also suggested that the program may be effective in improving exercise tolerance. The mixed-methods qualitative study found that patients enjoyed the program and perceived the program as beneficial. iii While chest physiotherapy, in particular airway clearance techniques, are the most common interventions used by physiotherapists, there is little evidence to support use of these techniques for all patients with an AECOPD. An early exercise program was safe and feasible and may potentially be effective for this patient population. If the exercise program is found to be effective, early implementation of an exercise program may change physiotherapy practice and contribute to improved outcomes for patients with an AECOPD.Submission note: A thesis submitted in partial fulfilment of the requirements for the degree of Professional Doctorate of Physiotherapy (Research) by published work to the Department of Physiotherapy, School of Allied Health, Faculty of Health Science, La Trobe University, Bundoora.Thesis with publications