Minimum standards for physical therapists providing rehabilitation care for people with chronic respiratory diseases in Japan: An e-Delphi study

Abstract

Rehabilitation interventions, including structured pulmonary rehabilitation (PR) programs, can improve symptoms, exercise tolerance, and quality of life for people with chronic respiratory diseases. However, in Japan, physical therapists provide rehabilitation care across care pathways both within and outside formal PR programs, and consensus-based minimum standards for physical therapists’ essential knowledge and skills have not yet been clearly articulated. This study aimed to establish expert consensus on the minimum standards (essential knowledge and skills) required for physical therapists providing rehabilitation care for people with chronic respiratory diseases in Japan, irrespective of whether care is delivered within a formal pulmonary rehabilitation program. A two-round e-Delphi study was conducted. An expert panel of 39 experienced physical therapists from Japanese clinical and academic settings evaluated 114 potential items for inclusion as minimum standards based on a predefined 70% consensus threshold. Consensus was achieved for 105 items. The final standards span knowledge relevant to chronic respiratory disease (CRD) rehabilitation care (including common management approaches and relevant devices), patient assessment and outcome measurement (including respiratory and physical function, activity/activities of daily living (ADL), and patient-reported outcomes), and rehabilitation interventions (including exercise and activity/ADL training). Items specific to invasive line management/monitoring (e.g., arterial line–related competencies) did not reach consensus, consistent with the intent to define baseline standards across CRD rehabilitation contexts rather than intensive care unit (ICU)-specific practice standards. These standards could inform training curricula and continuing professional development, help guide policy-making and service planning by clarifying baseline expectations across care settings, and provide a reference point for future cross-national comparisons following contextual adaptation. Future research should evaluate implementation feasibility in diverse healthcare settings and support periodic review and updating of the standards as clinical evidence and service contexts evolve.