Pioneering lung researchers boost Monash physiotherapy

Professor Anne Holland joins CCS. 
Photo: Anne Crawford

by Anne Crawford

Central Clinical School (CCS) in partnership with Alfred Health has gained a powerhouse team of researchers in the field of non-pharmacological chronic respiratory disease rehabilitation, making it one of the few sites in the world that specialises in this field.

Professor Anne Holland, a practising physiotherapist and world-leading researcher, heads the group, which is focussing on research and clinical trials in rehabilitation for pulmonary fibrosis and on interventions to improve the wellbeing of people with chronic obstructive pulmonary disease (COPD).

Professor Holland and her team, which includes clinician-researchers based both in Australia and internationally, joined Monash University’s Department of Allergy, Immunology and Respiratory Medicine from La Trobe University this month. The team’s addition significantly boosts the clinical trial focus at the Alfred site.

“It is a great opportunity for our team to join the CCS, which has a stellar reputation in clinical trials and translational medicine. I am also looking forward to growing our collaborations with Respiratory Medicine and Allied Health at the Alfred,” Professor Holland said.

Professor Holland is developing new models of rehabilitative care to improve the access and uptake of programs currently under-used by patients with chronic respiratory disease. Strong evidence has demonstrated the effectiveness of rehabilitative treatment yet less than 10% of patients needing this care are able to access it, she said.

“People who come into rehabilitation with really distressing breathlessness, no energy, very limited physical ability and eight weeks later have symptoms that are so much better,” she said. “You can make a huge difference to these peoples’ lives – it’s just a matter of getting them to that service.”

To this end, the team is developing and testing new methods of treatment.

A clinical trial into a low-cost home-based pulmonary rehabilitation service has shown a beneficial outcome to patients equivalent to that of the traditional centre-based model, Professor Holland said. The team received a Medical Research Future Fund (MRFF) grant to look at the implementation of this model across Australia and is trialling it across 14 sites. It will also test home-based rehabilitation to improve access to care for patients who have recently been discharged from hospital in an NHMRC-funded trial led by Dr Narelle Cox, due to start in the next six months. 

The researchers developed and tested a tele-rehabilitation model for outpatients of The Alfred, The Austin and Wimmera Base Hospital in Horsham, in which a virtual group of five patients using tablets and exercise bikes is guided by a physiotherapist. People living around Horsham currently have a return trip of up to 200 kilometres to access centre-based rehabilitation services, which precludes many people from attending. Professor Holland said the new tele-rehabilitation method has been well accepted to date by the mainly older group of patients.

If the trials are successful, Professor Holland will work with peak bodies such as the Thoracic Society of Australia and New Zealand, and Lung Foundation Australia, to push for changes in government funding to ensure these Allied Health services are covered. 

“Our work, which moves care into the community and into the home, is timely. Hospital-based treatment is expensive – we can’t afford it in a society with an ageing population.”

Professor Holland is also working to spread the word on physiotherapist-led rehabilitation to general practitioners who may be unaware of the benefits of such care or reluctant to recommend an allied health treatment. She said creating robust evidence was important to changing attitudes about Allied Health.

“Allied Health has not had a strong scientific identity and evidence base for nearly as long as medicine has, it’s come to this relatively recently,” she said. “My philosophy is that you do the best science you can – it’s hard to argue with the best science. That’s why I’ve had such a strong focus on clinical trials and on the latest methodology.”

Professor Holland, who has held a clinical appointment at The Alfred for more than 20 years, has a strong track record in conducting ground-breaking research and having it implemented to improve the lives of patients.

“We did the first-ever trial for pulmonary fibrosis rehabilitation and continued to grow this research program, which has now become a standard part of clinical care across the world,” she said. “That particular population of patients often don’t have many treatment options.

“A lot of our work is cited in guidelines for the management of COPD and pulmonary fibrosis making our group fairly visible on the world stage.”

Professor Holland is currently leading a multi-national trial of ambulatory oxygen therapy for people with fibrotic lung disease.

Her papers have been cited more than 10,000 times. In 2016, her work was recognised by an award from the American Thoracic Society for contribution to the science and practice of pulmonary rehabilitation. “That was a highlight because I guess it was an international recognition of the whole team’s work in the field and of its impact across the world.”

The award raised the group’s profile and helped create leadership opportunities for Professor Holland. She currently sits on the board of the Society as chair of the Pulmonary Rehabilitation Assembly.

“I was the first physio, I think, to do that and am from outside the US. It was an amazing opportunity to be involved in that global organisation.”

Another career highlight was Professor Holland’s service on the board of the Thoracic Society of Australia and New Zealand for four years. “I was definitely the first physio to sit on that board – an important step forward for our discipline.”

Professor Holland said she has also enjoyed being involved in policy and strategy on matters including the effects of cigarette smoking on health and strategies to counter the current silicosis epidemic.

“I hope that our new phase at Monash will be the springboard to take our clinical trials program to the next level, in terms of both methodology and scope. I look forward to growing our program and providing new opportunities for early- and mid-career researchers in respiratory health.”