Adherence to Pulmonary Rehabilitation in COPD

Abstract

Purpose: Adherence to pulmonary rehabilitation (PR) is low. This qualitative study used the PRECEDE model to identify predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors acting as barriers or facilitators of adherence to PR, and elicit recommendations for solutions from patients with chronic obstructive pulmonary disease (COPD). Methods: Focus groups with COPD patients who had attended PR in the past year were conducted. Sessions were recorded, transcribed verbatim, and coded independently by 2 coders, who then jointly decided on the final coding scheme. Data were summarized across groups, and analysis was used a thematic approach with constant comparative method to generate categories. Results: Five focus groups with 24 participants each were conducted. Participants (mean age 62 yr) were 54% male, and 67% black. More than half had annual income less than $20 000, 17% were current smokers, and 54% had low adherence (less than 35% of prescribed PR sessions). The most prominent barriers included physical ailments and lack of motivation (intrapersonal), no support system (interpersonal), transportation difficulties, and financial burden (structural). The most prominent facilitators included health improvement, personal determination (intrapersonal), support from peers, family, and friends (interpersonal), and program features such as friendly staff and educational component of sessions (structural). Proposed solutions included incentives to maintain motivation, tobacco cessation support (intrapersonal), educating the entire family (interpersonal), transportation assistance, flexible program scheduling, and financial assistance (structural). Conclusion: Health limitations, social support, transportation and financial difficulties, and program features impact ability of patients to attend PR. Interventions addressing these interpersonal, intrapersonal, and structural barriers are needed to facilitate adherence to PR.

Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT

“…Even though adherence was good in this study, poor adherence in the general context of PR is common [ 71 ]. Lifestyle changes, which are part of the PR goals [ 32 ], require a great degree of effort from both clinicians and patients.…”

‘It’s not one size fits all’: a qualitative study of patients’ and healthcare professionals’ views of self-management for bronchiectasis

“…The merits of peer support have been highlighted previously 35 but not always prioritised by HCPs who often favour symptom management and clinical outcomes. 36 Peer support has been found to sustain change in health behaviours 37 and patients’ engagement with self-management. 30 Consensus from our study demonstrates that patients benefit from peer support, but it is unclear whether one-to-one self-management programmes or a group format are most beneficial.…”

Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis

“…This is an important consideration when designing alternative interventions to address barriers to activity promotion strategies. One of the barriers to conventional pulmonary rehabilitation is the time commitment, both the amount of time required to travel to attend in-person sessions and the amount of time required to complete the rehabilitation sessions [ 29 , 30 ]. Presumably, time is less of a burden for a web-based intervention that does not require travel or in-person sessions, although we still found that age was positively associated with believing it was easy to find time to use the website.…”