Evidence-Based Respiratory Physiotherapy and Pulmonary Rehabilitation in Malta – The Way Forward

On 30 November, a seminar held in Malta in collaboration with CMEx highlighted the significant progress and future direction of evidence-based respiratory physiotherapy and pulmonary rehabilitation (PR) in Malta. Dr Anabel Sciriha presented an extensive overview of the evolution of respiratory care practices, her academic and clinical journey, and the research-driven advances shaping patient outcomes across chronic respiratory conditions.

Shifting Paradigms in Respiratory Physiotherapy

Historically, routine chest physiotherapy (RCP) was widely considered essential in the management of respiratory disorders. However, systematic reviews have not provided definitive evidence to support these traditional manual techniques. Current recommendations emphasise the importance of evidence-based practice, structured education, and alignment with international standards, reflecting the broader global movement towards high-quality, research-informed care.

A Research-Driven Professional Journey

Dr Sciriha’s work has been pivotal in advancing pulmonary rehabilitation in Malta. Her academic milestones—ranging from early studies in 2009 on inspiratory muscle training to her PhD completion in 2017—have contributed substantially to the understanding of COPD and interstitial lung disease (ILD) rehabilitation. Her research has been presented locally and internationally, including at the European Respiratory Society (ERS), WCPT, and National Symposium of Health Sciences, positioning Malta firmly within global clinical discourse.

Clinical Evidence: Impact of Pulmonary Rehabilitation

Across multiple studies, the benefits of Pulmonary Rehabilitation(PR) for patients with COPD and pulmonary fibrosis are consistent and significant. A structured 12-week programme, consisting of twice-weekly exercise and education sessions, demonstrated improvements in:

+Functional capacity

+Dyspnoea scores

+Health-related quality of life

+Psychological well-being

Both high-intensity and low-intensity programmes produced measurable gains. Notably, low-intensity PR emerged as a viable option for more severe or recently exacerbated COPD patients—supporting increased accessibility and potentially reducing hospital admissions.

For Interstitial Lung Disease patients, improvements were most pronounced in those with higher disease severity, with benefits maintained to some degree even one year post-programme.

Expanding the Scope: Adjunct Therapies

The seminar also highlighted the growing role of neuromuscular electrical stimulation (NMES) as an adjunct to Pulmonary Rehabilitation.Evidence suggests NMES can enhance muscle strength, improve oxidative capacity, and support patients too symptomatic to engage fully in active training, offering a promising gateway into more progressive exercise regimens.

Looking Ahead

The body of research presented underscores the importance of integrated, multidisciplinary pulmonary rehabilitation in improving patient outcomes for chronic respiratory conditions. As Malta continues refining its clinical services, further research and programme expansion are expected to strengthen the national respiratory care framework.

The seminar reinforced a clear message: evidence-based practice, continued professional development, and patient-centred rehabilitation are key to the future of respiratory physiotherapy in Malta.

Dr Anabel Sciriha | PhD (Melit) MMAP

Senior Lecturer

Department of Physiotherapy

Faculty of Health Sciences