The British Thoracic Society guideline on pulmonary rehabilitation in adults: your opinion is noted.
نویسندگان
چکیده
We thank Professors McConnell and Gosselink for their interest in the British Thoracic Society (BTS) pulmonary rehabilitation guideline. 2 We welcome the opportunity to highlight the robust, unbiased approach that the guideline development group (GDG) has followed in making their recommendations which have been accredited by National Institute of Health and Care Excellence. This process, according to the BTS production manual, is described in the guideline methodology. It included initial training, each article being considered by at least two GDG members, independent peer review at multiple stages and consultation periods for the public and stakeholders. Continuously updated declaration of interest forms were submitted. The correspondents question why inspiratory muscle training (IMT) is not recommended as a routine adjunct to pulmonary rehabilitation. The guideline discusses the background to IMT and the nature of the trials undertaken, including a considered judgement of the risk of bias therein. The randomised controlled trials (RCTs) at lowest risk of bias found IMT was of no benefit as an adjunct to the primary aims of rehabilitation, and hence it was not routinely recommended. A similar statement has been adopted in the recent American Thoracic Society/ European Respiratory Society statement on pulmonary rehabilitation. The label of ‘1+’ is a standard assessment of the evidence level informing the recommendation, not of the strength of support for using the named intervention. As the trials included exercise rather than multidisciplinary pulmonary rehabilitation, the recommendation was at Grade B. A high-quality RCTof high-intensity IMT in parallel to pulmonary rehabilitation focusing on functional exercise capacity and health status is required. As we state, consideration of individual interventions such as role of oxygen or IMT in isolation was beyond the remit of the guideline. In relation to limb resistance training, the correspondents have omitted the first evidence statement documented in the guideline against this adjunct:
منابع مشابه
Commentary: the British Thoracic Society guideline on pulmonary rehabilitation in adults
To cite: Bolton CE, Singh SJ, Walker PP, et al. Thorax 2013;68:887–888. ABSTRACT The first British Thoracic Society guideline on pulmonary rehabilitation in adults is published in the accompanying Thorax supplement. Focusing on delivery of a quality pulmonary rehabilitation service, the evidenced-based guideline encompasses recommendations on the composition of the service, referral of patients...
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عنوان ژورنال:
- Thorax
دوره 69 4 شماره
صفحات -
تاریخ انتشار 2014