Implementation of pulmonary rehabilitation in Nigeria: perspectives of clinical stakeholders (physicians and physiotherapists)

Pulmonary rehabilitation (PR) helps improve patients’ symptoms, restore functional abilities and enhance overall quality of life among people living with chronic respiratory diseases. Effective PR implementation requires a multidisciplinary approach, but this appears non-existent in Nigeria. The aim of this study was to assess the implementation of PR and explore the perspectives of clinical stakeholders on multidisciplinary approach to PR in Nigeria. A sequential explanatory mixed-methods study was utilised, consisting of a cross-sectional survey which involved 183 physicians and 156 physiotherapists and in-depth interviews with 6 purposively selected cardiopulmonary physiotherapists and pulmonologists. Quantitative data was summarised in frequencies and percentages. Inductive thematic analysis was used to analyse qualitative data. Of the 339 survey participants, 191 (79 (43.2%) physicians and 112 (71.8%) physiotherapists) reported that PR or related activities have been conducted in their hospitals, 87 (45.5%) of whom reported that there is no well-established rehabilitation system. From the interviews, it was deduced that although PR components are being practiced in some hospitals, multidisciplinary approach of PR is non-existent. Factors reported to affect PR implementation include lack of PR knowledge among physicians, insufficient training and specialised PR experts, inadequate facilities for PR and lack of institutionalised PR protocols. Recommendations to foster PR implementation include advocacy for PR, continued education of physicians on PR, establishing institutionalised PR protocols and advocating for resources to establish PR centres. Although PR is being practiced in a fragmented manner, the multidisciplinary approach of PR, supported by policy, needs to be integrated into Nigerian system. This can be achieved by structured learning, advocacy and policy documents for implementation.