The Montafon proposal: New insights and emerging concepts in pulmonary rehabilitation

Background Pulmonary rehabilitation (PR) is beneficial, yet outcome assessment remains inconsistent. A multidisciplinary D-A-CH working group reviewed evidence, introduced new measures, and explored emerging PR concepts. Summary The meeting emphasized patient-reported (PROMs) and clinician-reported (CROMs) outcome measures. A key focus was the minimal clinically important difference (MCID), a widely used metric which is applied inconsistently and is highly dependent on the baseline value. The 'performance score' (T2D = T2 + (T2 - T1)) takes baseline status (T1) into account by combining the discharge value (T2) with the improvement (T2 - T1) before and after treatment, based on the distribution. This simple descriptive approach results in a baseline-adjusted MCID estimator, with a planned multicenter study to validate its use in COPD rehabilitation. Further discussions addressed epistemic trust, crucial for patient adherence and interdisciplinary collaboration, with a study planned to assess its impact. Dysfunctional breathing (DB), often overlooked in PR, was highlighted, emphasizing the need for standardized diagnostic tools. The role of artificial intelligence (AI) in PR, including large language models, was explored, with surveys planned to evaluate patient and provider perceptions. Key Messages The T2D performance score offers a dynamic approach to assessing PR progress, addressing MCID limitations. Standardized methods for epistemic trust and DB diagnosis are essential for better recognition and management. AI integration in PR presents opportunities for personalized rehabilitation but requires further evaluation. The D-A-CH working group remains committed to advancing PR through evidence-based strategies and international collaboration.