Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Predictors of Program Completion and Success

Abstract

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.

A Cohort Study to Evaluate the Feasibility of Low Load/High Repetition Elastic Band Resistance Training for People with Chronic Obstructive Pulmonary Disease

“…Nevertheless, the results are of importance since people with moderate disease are one of the larger groups in the COPD population [32]. However, it would be of interest to investigate the feasibility of the exercise regimen also in people with were severe disease as adherence to pulmonary rehabilitation has been shown to be lower in those with larger ventilator restraints [33,34]. Also, there were some missing data which may have led to bias [26].…”

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

“…Pulmonary rehabilitation (PR) is a multidimensional, non-pharmacological intervention that has been established as the standard of care for the management of this condition 2. PR programmes (which include supervised exercise training) have been shown in clinical trials to improve exercise capacity,3–5 reduce dyspnoea,6 7 anxiety and depression,8 9 while improving quality of life7 among patients with COPD, and these findings are supported by data from clinical practice 10–12…”

Non‐anaemic iron deficiency in COPD: A potential therapeutic target?

“…11 Although PR has a compelling evidence base, not all patients with COPD achieve a clinically significant improvement. 12 This may be related to baseline characteristics, but many are not modifiable.…”