Differences in content and organizational aspects of pulmonary rehabilitation programs.

Objective: To study the overall content and organizational aspects of pulmonary rehabilitation programs from a global perspective to get an initial appraisal on the degree of heterogeneity worldwide. Methods: A twelve-question survey on content and organizational aspects was completed by representatives of pulmonary rehabilitation programs that previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Scientific Groups 01.02 (Rehabilitation and Chronic Care) and/or 09.02 (Physiotherapy), all members of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and all ATS Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings. Results: The survey has been completed by representatives of 430 centres from 40 countries. The findings demonstrate large differences among pulmonary rehabilitation programs across continents for all aspects that were surveyed, including the setting, the case-mix of individuals with a chronic respiratory disease, composition of the pulmonary rehabilitation team, completion rates, methods of referral, and types of reimbursement. Conclusions: The current findings stress the importance of future development of process and performance metrics to monitor pulmonary rehabilitation programs, to be able to start international benchmarking, and to provide recommendations for international standards based on evidence and best practice.