Pulmonary Rehabilitation in COPD

The Pulmonary Rehabilitation (PR) Impact Model on Exacerbations (PRIME), demonstrates the potential impact of Physiotherapy-led PR on exacerbations of COPD. Here, you can find and share the evidence for your area.


You can use the PRIME tool to review data for your area, practice or CCG, and benchmark against other areas. The PRIME tool gives information that you can use to:

  • make a business case for service improvement in your area
  • break down costs to support a business case
  • demonstrate the quality and impact of your service
  • consider best practice recommendations for improving your PR service

Share the evidence for physiotherapy

The model proposes, if every eligible COPD patient in England*is referred to a Physiotherapy-led PR programme, the following benefits will be observed for both patients and services:

  • A reduction of 1/3 exacerbations in this patient population. This equates to 150,924 fewer exacerbations, freeing up this number of appointments in primary care.
  • 26,633 avoided hospital admissions
  • 106,532 hospital bed day**
  • PR saves money. The amount of money is dependent on a number of factors, including non-completion rates. The higher completion rate, the greater the amount of money saved. Furthermore, the tool does not take into account the effect of PR on social care costs, and other the social value of the activity itself (helping to prevent loneliness and isolation for example).

*Due to limitations of data availability, PRIME tool currently uses figures from England. However, the tool can still be uses by other regions, by using local data where available.

**Based on BTS/RCP National Clinical Audit Report 2015, average length of stay per COPD exacerbation admission = 4 days

Who developed the tool?

The tool was developed in collaboration between the CSP and a number of different parties, including;

  • The Association of Chartered Physiotherapists in Respiratory Care (ACPRC)
  • Imperial College London (ICL)

A CSP member led expert steering group, including;

  • Julia Bott (Chair) (Consultant Respiratory Physiotherapist, Respiratory Programme Clinical Co-lead KSS),
  • Professor Sally Singh (Head of Cardiac & Pulmonary Rehabilitation, University of Leicester Hospitals NHS Trust)
  • Professor Anne Bruton (Professor of Respiratory Rehabilitation, Southampton University)
  • Maria Buxton (Consultant Respiratory Physiotherapist, London Northwest Hospitals Trust)
  • Ian Culligan (Lead Physiotherapist for Pulmonary Rehabiliation, Victoria Central Hospital and ACPRC Vice Chair)

The PRIME tool

The PRIME tool shows the significant positive impact that a Physiotherapy-led PR programme has on reducing COPD exacerbations and their associated management in primary and secondary care. It demonstrates that a significant number of admissions to A&E departments and hospitals, can be avoided as a direct result of Physiotherapy led PR programmes.

The tool brings together data from high-quality sources including Randomised Controlled Trails (RCTs), Clinical Practice Research Datalink data (CPRD) and the British Thoracic Society (BTS)/Royal College of Physicians (RCP) audit.

The tool also includes Recommendations from a panel of CSP member Physiotherapy experts, working in the field of respiratory care and PR (the Steering Group).

Key messages include:

  • PR services must deliver on quality (as defined by BTS standards), with regards to assessment, exercise prescription, training, progression and education if they are to deliver the expected outcomes
  • PR is an effective service, internationally recognised and demonstratively effective at managing exacerbation rates for COPD patients (as evidenced in RCTs)
  • There is a clear need for respiratory physiotherapists to be included in every PR team to manage the exercise prescription needs of the more complex patients

Download the PRIME tool

We suggest downloading and saving the spreadsheet. You can then alter the inputs on the model on your local computer, saving a personalised version for later use.

For further support or technical assistance, please email the CSP's Enquiries Team on enquiries@csp.org.uk.


This resource is funded
by the CSP Charitable Trust

Supportive materials

As well as the user guidance notes within the model, there are a number of resources to help support you to use the model:

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