Exploring strength assessment and strength training practices in pulmonary rehabilitation: insights from an online survey across England

Abstract

Abstract Background Strength training (ST) and strength assessment (SA) are recommended within pulmonary rehabilitation (PR) to address muscle weakness, a common consequence of chronic respiratory diseases, such as COPD. However, clear guidance on use and implementation is limited, posing challenges for PR services attempting to deliver evidence-based and effective ST and SA in practice. Therefore, this study aimed to provide a more detailed picture of provision by investigating ST and SA in PR services in England. Methods A cross-sectional online survey was conducted with 219 practitioners (physiotherapists, therapy/healthcare assistants, nurses) involved in PR delivery. Data collection included ST and SA use, practitioner training, attitudes, and perceived barriers. The sampling method was purposive, with participants recruited, and the survey distributed, via participating research sites (NHS Trusts and non-NHS organisations). Descriptive statistics summarised findings, and binary logistic regression explored preliminary factors associated with SA use. Results Less than half of participants (47%) reported their service used a SA, with sit-to-stand and repetition maximum variations most commonly used. Most reported the inclusion of ST (93.6%) but key prescription variables (intensity, load, volume, rest, progression) were addressed inconsistently. Furthermore, there were some questionable practices observed, such as sit-to-stand or bicep repetition maximum tests for SA, and Borg breathlessness scales for prescribing ST intensity. Perceived barriers included service-level constraints (time, equipment) and a lack of staff training. Specifically, the binary logistic regression showed that higher perceived service and colleague barriers, and lower practitioner confidence, were significantly associated with SA non-use. Conclusions Future research should investigate best practice within the parameters of real-world clinical settings and the resources they have available, with emphasise on clearer evidenced-based and effective guidance for ST and SA. Additional considerations include ensuring staff have relevant and high-quality training, developing tailored training resources for practitioners. Trial registration Not applicable.