Experiences of Pulmonary Rehabilitation in People Living with Chronic Obstructive Pulmonary Disease and Frailty. A Qualitative Interview Study

Abstract

Rationale: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from pulmonary rehabilitation but face challenges completing programs. However, research to understand ways to optimize participation in this group is lacking. Objectives: To explore the experiences, needs, and preferences of people with COPD and frailty referred for outpatient pulmonary rehabilitation. Methods: Semistructured interviews with people with COPD and physical frailty, purposively sampled by age, living status, level of frailty, and completion of pulmonary rehabilitation. Thematic analysis with a critical realist perspective was used, involving relevant stakeholders with clinical, academic, and lived experience for interpretive rigor. Results: Nineteen people with COPD and frailty were interviewed, with a median age of 78 years (range, 58–88). Nine did not complete their pulmonary rehabilitation program. Four themes were identified: striving to adapt to multidimensional loss, tensions of balancing support with independence, pulmonary rehabilitation as a challenge worth facing, and overcoming unpredictable disruptions to participation. Participants described constantly adapting to their changing health and resulting multidimensional losses (e.g., functional abilities, relationships, confidence). This involved traversing between independence and seeking support, set against a mismatch between their needs and what support is available. People with COPD and frailty can be highly motivated to participate in pulmonary rehabilitation, despite the physical and mental demands it entails, and report a range of benefits. Yet in the context of changeable health, they must often overcome multiple unpredictable disruptions to completing rehabilitation programs. Participant determination and flexibility of services can facilitate ongoing attendance, but for some, these unpredictable disruptions erode their motivation to attend. Conclusions: People with COPD and frailty experience accumulating, multidimensional loss. This group are motivated to complete pulmonary rehabilitation but often require additional support and flexibility owing to fluctuating and unpredictable health. Person-centered approaches should be considered to minimize disruptive health events and support pulmonary rehabilitation participation and completion. Service adaptations could allow more flexibility to meet the changing needs of this group and enable communication around how pulmonary rehabilitation might align with their priorities.

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

“…dyspnoea severity, exercise tolerance, frailty) affect pulmonary rehabilitation outcomes. 10,58,59 Four qualitative studies explored experiences of, and reasons for (non-)participation in, exercise-based interventions (primarily pulmonary rehabilitation [60][61][62][63] ). One case series described three peoples' journeys through geriatric rehabilitation.…”

“…Authors noted how this population frequently present with lower levels of function and health, and higher levels of dyspnoea, distress relating to dyspnoea, disability, and comorbidities, 10,19,21,48,[59][60][61][62][63][64][65][66][67][68]73,74 including comorbid psychiatric illness and cognitive dysfunction. 56,61 This was further complicated by their risk of significant health events or deterioration during exercise-based interventions. 10,19,21,61,64,68 People's health influenced how they saw themselves and services, contributing to feelings of shame 60 or losses of control.…”

“…56,61 This was further complicated by their risk of significant health events or deterioration during exercise-based interventions. 10,19,21,61,64,68 People's health influenced how they saw themselves and services, contributing to feelings of shame 60 or losses of control. 62,63,66 Participants reported feeling too unwell or too frail to participate in exercise, 60,61,63,65 especially in the context of other comorbidities.…”

“…10,19,21,61,64,68 People's health influenced how they saw themselves and services, contributing to feelings of shame 60 or losses of control. 62,63,66 Participants reported feeling too unwell or too frail to participate in exercise, 60,61,63,65 especially in the context of other comorbidities. 60,63 Our service user and professional stakeholders also felt social isolation was important, acting as both a barrier to, and facilitator of, participation.…”

“…60,63 Our service user and professional stakeholders also felt social isolation was important, acting as both a barrier to, and facilitator of, participation. Altogether, these factors influenced individuals' perceptions of exercise-based interventions in relation to their priorities, [60][61][62][63]69 as well as their physical ability to engage.…”