Physiotherapy (or physical therapy) is primarily concerned with developing, maintaining and restoring an individual’s maximum movement and functional ability. It includes examination/assessment, evaluation, diagnosis, prognosis/ planning of treatment, intervention/treatment, and re-examination. The conceptual framework most frequently used by physiotherapists is the international classification of function; the main goal of this classification is to enhance the patient’s participation in everyday life. In patients with respiratory conditions, physiotherapy includes, but is not limited to, chest physiotherapy or clearance of secretions, and breathing exercises. In recent years, the evidence base for the use of physiotherapy in the form of exercise training has grown in many areas, ranging from intensive care to chronic respiratory conditions.
Physiotherapy services can be used at all ages and at all stages of disease, from early diagnosis, through chronic illness, to acute episodes and care at the terminal stage. As such, physiotherapists have a clear and specific role in most clinical care pathways. The physiotherapist’s role in patient care includes assessment, advice, education and hands-on intervention. Traditionally, respiratory physiotherapists aid the mobilisation and removal of secretions. However, this is only one of the many problems physiotherapists can address. They aim to:
- maintain or improve exercise tolerance
- improve functional abilities (i.e. carrying out daily tasks)
- maintain and improve physical activity, coaching patients toward improving healthy behaviour
- reduce breathlessness and the work of breathing
- improve the efficiency of ventilation
- support weaning from mechanical ventilation and set up noninvasive mechanical ventilation
- mobilise and aid the expectoration of secretions (coughing up of mucus)
- improve knowledge and understanding
- reduce (thoracic) pain.
Training
Like nurses, respiratory physiotherapists are often nonspecialised. However, in many European countries, increasing numbers specialise in respiratory physiotherapy and rehabilitation. The ERS has encouraged such specialisation by launching the HERMES respiratory physiotherapy programme, which aims to provide a standardised postgraduate programme of education and training. In a survey conducted to support this initiative, 64% of 107 respondents from over 30 countries reported that physiotherapy training is organised as an academic training programme in their country; 43% of these respondents reported that undergraduate training takes 3 years to complete and 32% reported that training modules are spread over 4 years.