Respiratory rehabilitation in chronic obstructive pulmonary disease: predictors of nonadherence. P. Young, M. Dewse, W. Fergusson, J. Kolbe. #ERS Journals Ltd 1999. ABSTRACT: Rehabilitation is now an integral part of chronic obstructive pulmonary disease (COPD) management. The objective of the study was to determine predictors of nonadherence to a COPD rehabilitation programme.Patients attending a COPD clinic were invited to participate in a 4 week, hospitalbased, outpatient, COPD rehabilitation programme conducted predominantly by respiratory physiotherapists. All potential participants undertook an interviewer administered questionnaire addressing social, economic, psychological and healthcare factors, and underwent baseline physiological measures. Subsequently they were classified as: 1) "adherent" group who completed the total programme (n=55) or 2) "nonadherent" group who refused or began but did not complete the programme (n=36).The nonadherent group compared to the adherent group were more likely to be divorced (22 versus 2%, p<0.005), live alone (39 versus 14%, p<0.02), and to live in rented accommodation (31 versus 6%, p<0.005). There were no differences between the two groups in terms of baseline physiological parameters (forced expiratory volume in one second, forced vital capacity, 6-min walk distance, oxygen saturation, perceived dyspnoea), quality of life domains (Chronic Respiratory Disease Questionnaire), or indices of COPD-related morbidity. The nonadherent group were more likely to be current smokers (28 versus 8%, p<0.02) and less likely to use inhaled corticosteroids (16 versus 42%, p<0.005). The nonadherent group was not significantly likely to be depressed, anxious, prone to hyperventilation or to have had previous emotional counselling and was more likely to be dissatisfied with diseasespecific social support (51 versus 2%, p<0.001).In conclusion, a substantial proportion of eligible subjects who did not participate in a chronic obstructive pulmonary disease rehabilitation programme were not more physiologically impaired, but were more likely to be: socially isolated, lack chronic obstructive pulmonary disease-related social support, still be smoking and be less compliant with other healthcare activities. Identification of one or more of these factors reliably allows prediction for nonadherence to a rehabilitation programme. Eur Respir J 1999; 13: 855±859. Rehabilitation is regarded as an integral component of a comprehensive management programme for chronic obstructive pulmonary disease (COPD) [1±3]. However, studies on adherence to COPD rehabilitation programmes are lacking. Most reports do not include details of the total population screened nor the refusal rate. However, it is clear from some prospective controlled studies that a large proportion of those screened were deemed ineligible [4,5] and that a further substantial proportion of eligible patients refused participation in the programme [4]. Adherence to therapy may be predicted by sociodemographic, psychological, physiological a...
An outpatient, hospital-based respiratory rehabilitation programme pragmatically adapted for clinical utility produces substantial and clinically significant improvements in exercise tolerance and QOL, similar in type and magnitude to those obtained in controlled clinical trials. There was an associated reduction in COPD-related morbidity. Such gains were mostly maintained for six months after completion of the programme. Thus respiratory rehabilitation must be regarded as an essential component of a comprehensive clinical programme for the management of COPD.
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