Effectiveness and feasibility of Post Exacerbation Pulmonary Rehabilitation (PEPR) in a real-world clinical setting. A quality improvement project

Agnieszka Lewko, Stephanie K Mansell, Melanie Irvin-Sellers

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Background: The implementation of Post-Exacerbation Pulmonary
Rehabilitation (PEPR) in clinical practice has some challenges.

Aims: The aim of this project was to evaluate the feasibility and effectiveness of PEPR in practice.

Material and methods: Data were collected prospectively from 112 patients referred to PEPR. Healthcare (HC) utilization was measured by 30- and 90-day readmissions (30R&90R) and emergency departments visits (30ED&90ED), and compared between PEPR completers, drop-outs, and decliners (Chi-squared test). Incremental cost effectiveness (ICER) was calculated. The Incremental
Shuttle Walk Test (ISWT), the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Breathing Problem Questionnaire (BPQ), and the Hospital Anxiety and Depression Score (HADS) were all assessed pre- and post-PEPR.

Results: Compared to PEPR completers (n = 38), PEPR decliners (n =
59) and drop-out patients (n = 15) had more 30&90ED attendances
(8% vs. 24% and 47%; χ2 = 4.31, p = 0.04 and χ2 = 9.60, p = 0.002,
respectively), 30R (5% vs. 20% and 27%; χ2 = 4.67, p = 0.03 and χ2
= 4.44, p = 0.04, respectively), and 90R (3% vs. 24% and 40%; χ2 =
7.93, p = 0.005 and χ2 = 12.39, p < 0.001, respectively). The ICER was
£7,248 (€8,394) in favor of the PEPR-completer group. There were significant improvements of mean difference in all assessment tests for patients who completed PEPR (95% CI), with the exception of their HADS score. In the ISWT, patients had a mean distance of 50.3 m (29.7 m pre-PEPR and 70.9 m post-PEPR; p < 0.001); patients had a mean score of -3.6 on the BPQ (-1.7 pre-PEPR, -5.4 post-PEPR; p = 0.001), and a mean CAT score of -4.3 (-1.9 pre-PEPR, -6.7
post-PEPR; p = 0.002).

Conclusion: : PEPR is feasible and cost-effective.
Several factors should be considered for HC quality and effectiveness improvement.
Original languageEnglish
Pages (from-to)12-23
Number of pages12
JournalPhysiotherapy Review
Issue number3
Publication statusPublished - 2021
Externally publishedYes

Bibliographical note

This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.


  • rehabilitation
  • pulmonary disease
  • chronic obstructive pulmonary disease (COPD)
  • patient readmission
  • outcome assessment (healthcare
  • quality of care


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