Assessment and management of frailty during pulmonary rehabilitation: An international survey of Australian and New Zealand clinicians

BackgroundFrailty is common among patients referred to pulmonary rehabilitation (PR) programs. While it is considered an independent predictor of program non-completion, people with frailty respond positively to PR. Clinicians' perspectives on assessing and managing frailty in PR has not been established. This study aimed to identify clinicians' current practices, perceptions, and opinions on assessing and managing frailty in people who attend PR in Australia and New Zealand.MethodsAn international online survey targeting healthcare professionals in Australia and New Zealand involved in PR programs using a combination of multiple-response closed-ended and open-ended questions. This survey study was reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).ResultsOf 103 responses, 89 healthcare professionals completed the survey (92.6% completion rate). Nineteen percent routinely assessed frailty, mostly using Short Physical Performance Battery (SPPB). Respondents reported the main considerations for choice of frailty assessment tools were ease of use and cost. The most common frailty indicators identified by respondents included falls history, low body weight, slow or aided gait, and muscle weakness. Seventy-nine percent believed PR to be appropriate to manage frailty in this population, while 94% desired additional resources in future guidelines. Suggestions to improve PR to better manage frailty included reshaping rehabilitation program content, and providing specific patient education. Future desired research priorities included improvements to frailty assessment tools, frailty-specific guidelines and workforce training.ConclusionThis study explores PR practices among clinicians in Australia and New Zealand, showing variability in frailty assessment and management. It provides a foundation for evaluating key aspects of PR models that can be tailored to these clients' needs and limitations.