Strength assessment and strength training in pulmonary rehabilitation

Chronic obstructive pulmonary disease (COPD) is a major disease with high prevalence, mortality, and morbidity. A commonly associated impairment is muscle weakness, which is considered an important systemic marker of the condition and is argued to be an essential variable for assessment and treatment. One successful treatment for COPD is pulmonary rehabilitation (PR), which is a comprehensive programme of exercise and education. Strength training (ST) is recommended in PR to target muscle weakness, along with the assessment of patient muscle strength. However, the use and impact of strength assessment (SA) and ST in PR clinical practice is unclear. First, this thesis conducted a narrative literature review to summarise and synthesise the most relevant literature surrounding SA and ST in COPD and PR. Next, two qualitative studies were carried out, exploring the perspectives and experiences of practitioners (n=11) and patients (n=12) in relation to SA and ST. Lastly, a survey of practitioners (n=219) investigated SA and ST use in PR services across England, as well as practitioner training, attitudes, and perceived barriers. Descriptive data was collected, and further statistical analyses performed that explored predictive factors of use/non-use. The findings show markedly limited guidance for the use of SA and ST in PR. Services report fulfilling basic recommendations, but methods in clinical practice vary. Feasibility is an essential consideration and another explanation for variance, specifically the impact of service-related barriers and differing resources. Staff training is an area of improvement, as many practitioners do not have relevant training despite SA and ST being included in PR programmes. Lastly, findings highlight the importance of patients having the necessary understanding, with education and support identified as a means of facilitation. Overall, successful implementation and use of SA and ST in PR clinical practice is multifactorial - influenced by services, practitioners, and patients.