TY - JOUR T1 - Heterogeneity of pulmonary rehabilitation: like apples and oranges – both healthy fruit JF - European Respiratory Journal JO - Eur Respir J SP - 1223 LP - 1226 DO - 10.1183/09031936.00021114 VL - 43 IS - 5 AU - Carolyn L. Rochester AU - Antonio Spanevello Y1 - 2014/05/01 UR - http://erj.ersjournals.com/content/43/5/1223.abstract N2 - Pulmonary rehabilitation is an essential component of comprehensive integrated care, and indeed is one of the most effective interventions, for persons with chronic obstructive pulmonary disease (COPD) and other forms of chronic respiratory disease [1–4]. It has been convincingly demonstrated to improve patients’ exercise tolerance [4, 5], symptoms of dyspnoea [6] and quality of life [1], and to reduce anxiety, depression [7], hospitalisations for COPD exacerbations [1, 8, 9] and urgent healthcare utilisation [10]. It is effective even for persons with complex medical comorbidities such as concurrent cardiovascular and metabolic disease [11] and for chronically critically ill persons admitted to intensive care units [12]. Several published guidelines and statements on the science and optimal implementation of pulmonary rehabilitation exist [1, 13–17]. However, despite the extensive knowledge and published evidence base regarding its benefits pulmonary rehabilitation remains severely underutilised worldwide.In this issue of the European Respiratory Journal, Spruit et al. [18] report the findings of a 12-question survey, adapted from an existing survey of pulmonary rehabilitation [19, 20], regarding the content and organisational aspects of pulmonary rehabilitation programmes from 430 centres from 40 countries. The majority of respondents were from Europe and North America. The authors found a wide degree of heterogeneity in the content, components, structure and organisation of pulmonary rehabilitation programmes worldwide. Heterogeneity was found in terms of pulmonary rehabilitation programme setting, duration, source of funding and payer reimbursement, number and type of team members, referral sources, patient types, interventions provided, and outcomes measured. The authors conclude that it is important for pulmonary rehabilitation providers to consider development of uniform performance and process metrics … ER -