Pulmonary rehabilitation: Uptake and completion profile of patients with chronic obstructive pulmonary disease

Abstract

Background: Pulmonary rehabilitation (PR) is effective in the management of chronic obstructive pulmonary disease (COPD) patients. 33% of patients referred for PR do not start the programme.Aim: To examine the relationship between participation in outpatient PR and baseline measures of disease severity and psychosocial variables in COPD patients. Methods:In an observational study and prior to their first outpatient PR appointment, COPD patients completed outcome measures of depression (Brief Assessment Depression Card), social support (Duke Social Support Index), multidimensional health locus of control (MHLC) and COPD severity (Medical Research Council dyspnea score). Data on attendance at the PR appointments were obtained from the PR register.Results: Fifty-one patients (mean age 77.2 year, male= 20), completed the study. Results indicate that in a patient, the presence of depression has a moderate, but statistically significant association (p=0.02) with the uptake of PR. There was no significant correlation between uptake status and any of the domains of MHLC, DSSI or MRC (p>0.005). Conclusion:Patients with COPD and depression are less likely to take up a referral to PR compared to those without depression. None of social support, HLC and COPD severity has a relationship with the uptake or completion of outpatient PR.

The meaning of the name of ‘pulmonary rehabilitation’ and its influence on engagement with individuals with chronic lung disease

“…Furthermore, the proportion of individuals attending PR who have at least one other co-existing condition is between 51% and 96% meaning that motivation to engage in therapy ‘relating to the lungs’ may be overcome by the desire to attend to conditions not directly related to their respiratory disease. 7,11…”

“…Furthermore, the proportion of individuals attending PR who have at least one other co-existing condition is between 51% and 96% meaning that motivation to engage in therapy 'relating to the lungs' may be overcome by the desire to attend to conditions not directly related to their respiratory disease. 7,11 Our inquiries through 'Breath Lab' and ethnographic research conducted through the Life of Breath project have indicated that there is a hesitation to pursue PR due to a lack of clarity as to what the programme involves and what this means for individuals. This empirical research has revealed that many of those consulted with a lung condition initially considered that PR comprised breathing techniques, while others were concerned with the probability of compulsory, intense exercise.…”

“…Notably higher levels of anxiety were observed in those who suffered an acute exacerbation and discontinued PR compared to those who completed the programme. 6,7 That said, reasons for poor PR uptake and engagement are likely very complex and informed by sociocultural factors such as education level, religious beliefs and ethnicity. Recent work has looked at participation in PR noting that key issues include referral factors, such as lack of understanding what to expect; the importance of patient beliefs, such as fears about the effects of exercise on breathlessness or other symptoms; and social factors such as the support of family and friends, and adjustment to the programme, but the influence of language on understanding or expectations was not mentioned.…”