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Australia and New Zealand pulmonary rehabilitation -- clinical practice guidelines
Alison JA, McKeough ZJ, Johnston K, McNamara RJ, Spencer LM, Jenkins SC, Hill CJ, McDonald VM, Frith P, Cafarella P, Brooke M, Cameron-Tucker HL, Candy S, Cecins N, Chan ASL, Dale M, Dowman LM, Granger C, Halloran S, Jung P, Lee A, Leung R, Matulik T, Osadnik C, Roberts M, Walsh J, Wootton S, Holland AE [Lung Foundation Australia and the Thoracic Society of Australia and New Zealand]
practice guideline

AIM: The aim of the pulmonary rehabilitation guidelines (guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts. METHODS: The guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE criteria. The guidelines were externally reviewed by a panel of experts. RESULTS: The guideline panel recommended that people with mild to severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education program; that PR should be offered to people with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialised centres. The guideline panel was unable to make recommendations relating to PR program length beyond eight weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. CONCLUSION: The Australian and New Zealand pulmonary rehabilitation guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policy makers.

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