Impact of pulmonary rehabilitation on patients’ health care needs and asthma control: a quasi-experimental study

Abstract

Background Pulmonary rehabilitation offers potential benefits to people with asthma. It is however unknown if rehabilitation favourably affects patients’ health care needs. We therefore examined if rehabilitation reduced needs and, in addition, if it improved asthma control. Methods One hundred fifty patients with asthma were surveyed in three rehabilitation clinics at admission and at discharge. Additionally, we surveyed 78 participants with asthma twice 4 weeks apart. The latter sample (i.e. the control group) was recruited through other pathways than rehabilitation clinics. The Patient Needs in Asthma Treatment (NEAT) questionnaire and the Asthma Control Test (ACT) were completed at baseline and follow-up. Differences between baseline and follow-up and between rehabilitation and control group were examined by t-tests and chi-squared-tests. Univariate ANCOVAS were used to examine if NEAT and ACT follow-up scores differed significantly between groups. Within the rehabilitation group, linear regressions were used to examine if self-reported utilization of more interventions that addressed needs were associated with NEAT scores at follow-up. Results At baseline, there were no differences between the rehabilitation and the control group regarding needs and asthma control. At follow-up, the rehabilitation group showed reduced needs (t(149) = 10.33, p < 0.01) and increased asthma control (t(130) = -6.67, p < 0.01), whereas members of the control group exhibited no changes. Univariate ANCOVAS showed that unmet follow-up needs (F(1, 212) = 36.46, p < 0.001) and follow-up asthma control (F(1, 195) = 6.97, p = 0.009) differed significantly between groups. In the rehabilitation group, self-reported utilization of more interventions was associated with reduced needs (β = 0.21; p = 0.03). Conclusions This study provides preliminary evidence suggestion that pulmonary rehabilitation in adults with asthma may reduce asthma-related needs and confirms previous findings that rehabilitation may improve asthma control.

Implementing the Patient Needs in Asthma Treatment (NEAT) questionnaire in routine care: a qualitative study among patients and health professionals

“…Pulmonary rehabilitation staff, by contrast, was more likely to treat patients who experience asthma-related impairment, i.e., people who may have more unmet health care needs. This notion is supported by prior research: in a previous study we found a mean of 5.73 NEAT needs at admission to inpatient pulmonary rehabilitation [ 6 ] compared to 3.37 unmet needs in the present sample. Pulmonary rehabilitation staff was also more likely to describe patients as motivated.…”

“…The NEAT is a validated instrument [ 5 ] that has already been used in clinical practice, i.e., in three pulmonary rehabilitation clinics [ 6 ], and has now been evaluated together with patients and health professionals. Since the results indicate that the NEAT could be used primarily in the context of patient education, the NEAT should additionally be used and evaluated in the DMPs context.…”

“…Furthermore, with the support of the “HausarztNetz Düsseldorf” (HAND e.V., a network of GPs) we were able to reach another 144 GPs via an e-mail list. We were able to recruit the pulmonary rehabilitation staff with the help of two pulmonary rehabilitation clinics that had already supported us in previous research studies [ 6 , 10 , 15 – 17 ] (the number of potential participants contacted is unknown). After initial analyses, we decided to additionally survey medical assistants in pneumological or general practices given that Disease Management Programs 3 (DMPs) are also offered in the respective practice and the medical assistant confirms to have regular contact with patients with asthma in her/his daily work.…”

“…All interviews were conducted by JS (M.Sc., female), who has a background in psychology and pulmonary health services research [ 5 , 6 , 18 ]. Interviews were conducted until thematic saturation was reached, i.e., if it could be assumed that the inclusion of further individual cases does not result in further topic areas or greater knowledge [ 9 ].…”

“…We found that it is responsive to changes in treatment satisfaction and in asthma-related quality of life [ 5 ]. After its validation, the NEAT was administered in three rehabilitation clinics and we were able to provide preliminary evidence that pulmonary rehabilitation in adults with asthma may reduce asthma-related health care needs [ 6 ].…”