Occupational therapy (OT) and pulmonary rehabilitation (PR) of COPD patients

Wasterlain, Emmanuelle [UCL] Reychler, Gregory [UCL] Caty, Gilles [UCL]

Introduction.– Pulmonary Rehabilitation (PR) is an evidence-based and multidisciplinary intervention designed for COPD patients allowing to improve their autonomy in Activities of Daily Life (ADL) and their Quality Of Life (QOL). The intervention of an occupational therapist during comprehensive PR is now clearly demonstrated and recommended. Nevertheless, standardized protocols of intervention of Occupational Therapy (OT) and definition of OT's roles during PR are lacking. Aim and methods.– The aim of this study is to propose some guidelines about specific roles and interventions of OT during PR based on a review of the literature and our experience in Cliniques Universitaires Saint-Luc (CUSL). Results and discussion.– There is a lack of randomised controlled trials (RCT) about specific roles of OT during the PR. Following our experience in CUSL, the evaluation and the education of COPD patients can be considered as the key roles of the OT. Global OT intervention in PR should include at least: assessment of patient's autonomy in ADL; proposal of economical strategies, technical support and environment's modifications facilitating the ADLs’ achievement; COPD patient's self-management; therapeutic education sessions. Concerning the therapeutic education, the role of the occupational therapist is first to identify the patient's needs and the activities that pose difficulties in their daily lives through various tools (as the Canadian Model of Occupational Performance). Therapeutic education will then aim to reduce energy costs (for example, learning appropriate positions) and ventilatory costs (modification of activities’ procedure) of the patient in ADL. The occupational therapist also uses motivational interviewing in therapeutic education. It is necessary for behavioral changes and essential in patient's compliance during the PR. Conclusion.– OT is an effective intervention for COPD patients during PR that improves their ADL and QOL, and must be promoted to evaluate and solve problems related with respiratory disability. Although it lacks RCT, we can propose some clinical guidelines about specific roles of OT during PR.