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Abstract
Aim
To determine the opinion of health care professionals within Australia, regarding acceptable levels of exertion and symptoms, and referral for exercise rehabilitation in patients with pulmonary arterial hypertension (PAH).
Method
In 2010, 76 health care professionals at a specialist pulmonary hypertension meeting in Australia were surveyed using a self-administered questionnaire. The questionnaire included case studies of patients with PAH in World Health Organization (WHO) functional classes II–IV. For each case study, respondents were asked to report their opinion regarding the acceptable level of exertion and symptoms during daily activities, and whether they would refer the patient for exercise rehabilitation. Three additional questions asked about advice in relation to four specific physical activities.
Results
The response rate was 70% (n = 53). Overall, 58% of respondents recommended patients undertake daily activities ‘as tolerated’. There was no consensus regarding acceptable levels of breathlessness or fatigue, but the majority of respondents considered patients should have no chest pain (73%) and no more than mild light-headedness (92%) during daily activities. Overall, 63% of respondents would have referred patients for exercise rehabilitation. There was little difference in opinion regarding the acceptable level of exertion or symptoms, or referral for exercise rehabilitation, according to functional class. However, the patients’ functional class did influence the advice given regarding the specific physical activities.
Conclusion
In 2010, there were inconsistencies between individual health care professionals within Australia regarding appropriate levels of physical exertion and acceptable symptoms during daily activities. Almost two-thirds of the respondents reported they would refer patients for exercise rehabilitation.
Acknowledgments
The authors would like to acknowledge Peter McKinnon, Curtin University, for assistance with the statistical analyses; and the staff of Pfizer Pharmaceuticals Australia, for assistance with photocopying, distribution, and collection of the surveys.
Disclosures
This research was supported by Bayer Schering Pharmaceuticals and Actelion Pharmaceuticals Australia. Robin Fowler has received travel support from Bayer Schering, Actelion, and CSL and an Honorarium from Pfizer Australia. Andrew Maiorana has received travel support from Actelion. Eli Gabbay has received travel support, is on the Advisory Board and has received honoraria and research funding from Actelion and Pfizer. These funding bodies had no influence on the planning of this study, data collection, analysis or interpretation. Sue Jenkins, Kevin Gain, and Gerry O’Driscoll have no financial relationships with a commercial entity that has a commercial interest in the subject of the presented manuscript or other conflicts of interest to disclose.
The meeting organisers had no input or influence over the content of the questionnaire, the data analysis or this manuscript. They supported the project by photocopying, distributing, and collecting the questionnaires.
Author contributions
Robin Fowler was responsible for the design of this study, collection of the data, analysis and interpretation of the data and preparation of the manuscript. Sue Jenkins was responsible for the design of this study, interpretation of the data and preparation of the manuscript. Andrew Maiorana was responsible for the design of this study and preparation of the manuscript. Kevin Gain was responsible for analysis and interpretation of the data and preparation of the manuscript. Gerry O’Driscoll was responsible for the design of this study and preparation of the manuscript. Eli Gabbay was responsible for the design of this study, interpretation of the data and preparation of the manuscript.