Rapid access rehabilitation after exacerbations of chronic obstructive pulmonary disease: A Delphi study
Bibliographic record
Abstract
BACKGROUND Pulmonary rehabilitation (PR) improves function and health-related quality of life following acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is increasing interest in initiating rapid access rehabilitation (RAR) within 48 h of AECOPD discharge, to facilitate transition to home and conventional PR. In this report, we identify the practical considerations for the design and implementation of a RAR program.METHOD Healthcare professionals (HCP), policymakers (PM), and patients living with COPD were invited to participate in a 2-round e-Delphi process. They provided feedback on five RAR themes, identified from semi-structured interviews, using a 6-point Likert scale. The initial round 1 questionnaire included 196 statements for HCP and PM and 144 for patients.RESULTS A total of 38 participants were enrolled (17 HCP, 12 PM, and 9 patients). Participants agreed that RAR should be initiated within 1 to 3 weeks of discharge for motivated patients with frequent exacerbations and those with co-existing health conditions. The consensus was for a hybrid format, of 1 to 2-h sessions, several times a week for a total duration of 4 to 6 weeks, with the structure being modified by patients’ preferences. Factors to improve referral and uptake included educating patients and HCP about RAR benefits and having a patient ambassador to support patients.CONCLUSION Stakeholders reached consensus around characteristics for participant eligibility, program structure, treatment priorities, outcome measures, approaches to facilitate referral, uptake and implementation of RAR. Such information forms the basis of a testable RAR program for patients transitioning home from hospital or referred for PR following an AECOPD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.043 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".