An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD

Abstract

BackgroundPulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance.AimTo identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL).MethodsData were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. ‘Completion’ was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data.Results787 outpatients with COPD (68.1±10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL.ConclusionsPatients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.

Exercise training in interstitial lung disease: lumping or splitting?

“…In fact, those most limited at baseline tended to have the greatest short-term benefit from PR, a pattern that is also recognised in COPD13 and has been noted previously in ILD 14. On the other hand, those with the best preserved physiology were more likely to have long-term gains in exercise capacity.…”

An audit of pulmonary rehabilitation program

“…19 Current smokers had lowest rates of attendance, as documented by others. 20 Another concern in this region is the disparity of health of Māori and Pacific Islanders, who have an increased prevalence of COPD, bronchiectasis, and smoking.…”

Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales

“…Previous studies conducted in single centres or regions have investigated factors predicting PR adherence, completion and clinical response but due to limitations of sample size and geographical scope have not identified clear-cut patient level indicators predicting these outcomes. [7][8][9][10][11][12] In particular, it is unknown whether social deprivation (across the breadth of national socioeconomic strata) is a predictor of these…”