Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD), there are insufficient resources to provide PR to all patients with COPD. Thus, predicting which patients are at risk for drop-out and non-response to rehabilitation is necessary in order to optimize limited resources. This study examined which patient characteristics are predictive of PR drop-out and non-response. 814 patients with COPD took part in standard out-patient PR for 8 weeks. Demographic and standard clinical data were collected before the rehabilitation program had started. Data was analyzed retrospectively to determine if baseline patient characteristics could predict drop-out and non-response to rehabilitation. Drop-out was defined as participation in less than 50% of the rehabilitation sessions. Non-response was defined as improvement less than 4% on the St. George's Respiratory Questionnaire (SGRQ). A discriminant function analysis identified age, smoking history, and health status as predictors of patient drop-out, p < .0001, with younger, current smokers and patients with lower health status being at risk for drop-out. No variables measured significantly predicted who those at risk would be for non-response to rehabilitation, p > .05. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.

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1 2 RATIONALE: Improvements in health outcomes following Pulmonary Rehabilitation (PR) are often lost within 12 months following PR as patients with chronic obstructive pulmonary disease (COPD) fail to adhere to their exercise programs. Previous studies have used ongoing support from a respiratory professional to maintain exercise after PR; however, peer support programs have been proposed as a potential model to maintain healthy behaviors. We conducted a randomized controlled trial examining the effects of Peer Educator (PE) support vs. Respiratory Therapist (RT) support following PR. The purpose of this study was to compare patients' perceptions following either intervention. As COPD is a complex disease, and patients frequently have questions regarding their disease, we hypothesized that the RT support program would result in greater patient satisfaction as compared to PE support program. METHODS: 168 patients (mean age = 70±9yrs, FEV =57±22% predicted) completed a 6-8 week outpatient PR program. As part of PR, an exercise action plan was created for 1 each patient. Patients were subsequently randomized into one of three groups: 1. PE support, 2. Usual Care, 3. RT support. PE and RT support received 8 phone calls over a 6 month period. Each phone call consisted of standardized questions asked by either the PE or RT. Each patient was counseled about overcoming barriers to exercise based upon their responses. At the end of 6 months patients were interviewed by an independent person regarding their satisfaction with their support program. RESULTS: After the first phone call, 17 (10%) declined receiving any further phone calls. A total of 61 patients from the RT or PT groups were interviewed at 6 months. Of the patients receiving RT support, 91% were very satisfied. Only 1 patient stated that the program did not meet their needs, but they remained satisfied. Of the patients receiving PE support, 69% were very satisfied; one patient reported not being satisfied. When each patient was asked which program they would have preferred only 1 (3%) patient in the RT support program stated they would prefer PE support, whereas 8 (28%) of the patients in the PE support program would have preferred the RT support. Typical responses were that patients would have preferred receiving support from a medical professional. CONCLUSIONS: Overall, patients were satisfied with the support program. In comparing PE vs. RT support programs to maintain exercise following rehabilitation, COPD patients preferred support from a respiratory professional over one of their peers. This abstract is funded by: Alberta

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