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14-03-2013 | Respiratory | Article

Predictors of pulmonary rehabilitation attendance, adherence identified


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medwireNews: Results from a UK study show that smoking status, social support, and certain markers of disease severity are significant predictors of pulmonary rehabilitation (PR) attendance and adherence in patients with chronic obstructive pulmonary disease (COPD).

Andrew Wilson (University of East Anglia) and team found that long-term oxygen therapy (LTOT) and living alone were independent predictors of poor PR attendance, while current smoking, reduced walking test distance, and previous hospitalizations were independent predictors of poor PR adherence in patients with the lung disease.

Writing in Respiratory Medicine, the researchers explain that PR "is a multidisciplinary programme involving exercise training, disease education and behavioural interventions, which has been shown to significantly improve symptoms of dyspnoea and exercise capacity in patients with COPD."

But they add: "Uptake for PR is poor with attendance reported as being as low as 50%. In addition, 23-31% of patients who start the course fail to complete."

To investigate factors associated with PR attendance and adherence, the team studied data on 711 COPD patients who were invited to attend PR, which is recommended in national guidelines.

Overall, 31.8% of the referred patients did not attend any PR sessions and 29.1% were nonadherent, defined as attending five sessions or less.

The researchers found that a significantly lower proportion of women attended PR than men (62.8 vs 72.1%), as did current versus former smokers (56.6 vs 74.9%), and patients living alone versus those cohabiting (61.4 vs 73.7%).

Independent predictors of attendance were the use of LTOT (odds ratio [OR]=0.45) and cohabitation (OR=1.82).

Patients were more likely to be adherent if they were former rather than current smokers (79.9 vs 44.9%) and were not on LTOT (73.0 vs 59.3%).

Iindependent predictors of adherence were smoking status, walk distance, and hospital admissions, with ex-smokers (OR=7.59), patients with good exercise tolerance, and patients without previous hospitalization most likely to complete the PR course.

Wilson et al conclude: "We suggest that maximising medical therapy, providing concomitant smoking cessation service if appropriate and using a 'buddy' scheme may improve completion of PR programmes, but further studies are needed."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Mark Cowen, Senior medwireNews Reporter

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