Pulmonary rehabilitation guide – answering the questions that commissioners want answered

Pulmonary Rehabilitation

Produced by an expert task force of IMPRESS, this new guide on pulmonary rehabilitation services (PR) aims to answer the questions that most healthcare commissioners want answered. It supplements a Commissioning Pack for COPD due to be issued by the Department of Health England early in 2012.

Providing clinical leadership to the NHS to stimulate improvement and integration in respiratory services, IMPRESS is a joint initiative between the British Thoracic Society and the Primary Care Respiratory Society-UK

The evidence base

The research base for PR

is strong and consistently shows benefits to patients and softer evidence (speaking to physiotherapists, clinicians and especially patients and patient groups) emphasises the benefits that many gain

A guide for commissioners

It is important for commissioners to clarify the spend, the value and the outcomes that are currently achieved.

When planning to commission a new service there are increasingly good estimates to inform commissioners, taking into account local geography and specific health needs

Showing a firm grasp of the needs of commissioners, this guide

  • brings together the evidence available on the value of PR, its impact on mortality and readmissions for COPD exacerbations, its cost-effectiveness.
  • looks at modelling demand and capacity
  • recommends adapting the DH England service specification to the local situation and clarifies
  • some essential elements
  • recommends  outcome measures
  • examines costs
  • offers some key performance indicators
  • addresses coding issues


There is no doubt that pulmonary rehabilitation improves the quality of life significantly in many who are significantly disabled – and can reduce hospital admission and death rates

Given its proven clinical and cost effectiveness compared to many other interventions for COPD, the NHS should give priority to commissioning PR.  Further, the proposition from IMPRESS is that the more that components of the COPD pathway work together as an integrated programme the more likely there is to be a positive effect.


Williams, S et al. IMPRESS Guide to Pulmonary rehabilitation [PDF 3MB] IMPRESS, December 2011

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