BACKGROUND Completion of pulmonary rehabilitation is recognised in chronic obstructive pulmonary disease (COPD) guidelines as a key opportunity to consider systematically whether a respiratory review to assess potential suitability for a lung volume reduction (LVR) procedure might be appropriate. We describe the development of a simple decision-support tool (the LVR-PR tool) to aid clinicians working in pulmonary rehabilitation, to operationalise this process. METHODS We took an iterative mixed methods approach, which was partnership-based and involved an initial consensus survey, focus groups and an observational study cohort at multiple pulmonary rehabilitation centres. RESULTS Diagnosis (97%), exercise capacity (84%), breathlessness (78%) and co-morbidities (76%) were acknowledged to be essential items for assessing basic LVR eligibility. Collating prior investigations and assessing patient understanding were considered useful but not essential. Clinician concerns included; streamlining the tool; access to clinical information and investigations; and care needed around introducing LVR therapies to patients in a PR setting. Access to clearer information about LVR procedures, the clinician's role in considering eligibility and how educational resources should be delivered were identified as important themes from patient group discussions. The LVR-PR tool was considered to be feasible and valid for implementation in a variety of PR services across the UK subject to the provision of appropriate health professional training. Clinicians working in specialist LVR centres across the UK who were not otherwise involved in the development process confirmed the tool's validity using the content validity index (CVI). INTERPRETATION The LVR-PR tool appears to be an acceptable tool that can be feasibly implemented in PR services subject to good quality educational resources for both patients and healthcare professionals.

中文翻译：

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开发和实施肺减容肺康复工具，以确定慢性阻塞性肺疾病患者在肺康复过程中进行肺减容的资格。

背景 慢性阻塞性肺疾病 (COPD) 指南认为完成肺康复是系统考虑呼吸检查以评估肺减容术 (LVR) 手术潜在适宜性是否合适的关键机会。我们描述了一种简单的决策支持工具（LVR-PR 工具）的开发，以帮助从事肺康复工作的临床医生实施这一过程。方法 我们采用了迭代混合方法，该方法以伙伴关系为基础，涉及初步共识调查、焦点小组和多个肺康复中心的观察研究队列。结果 诊断（97%）、运动能力（84%）、呼吸困难（78%）和合并症（76%）被认为是评估基本 LVR 资格的重要项目。整理先前的调查和评估患者的理解被认为是有用的，但不是必需的。临床医生关心的问题包括：简化工具；获取临床信息和调查；以及在 PR 环境中向患者引入 LVR 疗法所需的护理。获得有关 LVR 程序的更清晰信息、临床医生在考虑资格方面的作用以及如何提供教育资源被确定为患者小组讨论的重要主题。LVR-PR 工具被认为在英国各地的各种公关服务中实施是可行且有效的，但前提是提供适当的卫生专业培训。在英国各地专业 LVR 中心工作的未参与开发过程的临床医生使用内容有效性指数 (CVI) 确认了该工具的有效性。解释 LVR-PR 工具似乎是一种可以接受的工具，可以在 PR 服务中可行地实施，但需要为患者和医疗保健专业人员提供优质的教育资源。