What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review

Abstract

Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence. Despite this, many people with COPD do not complete their program or choose not to attend at all. The aim of this study was to determine the factors associated with uptake and completion of pulmonary rehabilitation for people with COPD. Seven electronic databases were searched for qualitative or quantitative studies that documented factors associated with uptake and completion of pulmonary rehabilitation in people with COPD. Two reviewers independently extracted data, which was synthesized to provide overall themes. Travel and transport were consistently identified as barriers to both uptake and completion. A lack of perceived benefit of pulmonary rehabilitation also influenced both uptake and completion. The only demographic features that consistently predicted non-completion were being a current smoker (pooled odds ratio 0.17, 95% confidence interval 0.10 to 0.32) and depression. The limited data available regarding barriers to uptake indicated that disruption to usual routine, influence of the referring doctor and program timing were important. In conclusion poor access to transport and lack of perceived benefit affect uptake of pulmonary rehabilitation. Current smokers and patients who are depressed are at increased risk of non-completion. Enhancing attendance in pulmonary rehabilitation will require more attention to transportation, support for those at risk of non-completion and greater involvement of patients in informed decisions about their care.

The Reasons for Non-Adherence in Pulmonary Rehabilitation Programs

“…Another important reason affecting the adaptation was transportation problems (3,13,16). In the National Emphysema Treatment Trial (NETT), those living close to the PR centers were found to show higher attendance in the programs (17).…”

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

“…Previous studies have suggested that current smoking, a lack of perceived benefit and depression are all likely to represent barriers to uptake or increase non-completion. 35 …”

Influence of Ambient Music on Perceived Exertion During a Pulmonary Rehabilitation Session: A Randomized Crossover Study

“…Adherence to exercise training in pulmonary rehabilitation programs is variable and related more to psychosocial than physiological impairment. 1,2 It can be negatively influenced by dyspnea, anxiety, and perceived exertion. In 2006, the American Thoracic Society and European Respiratory Society mentioned in their joint statement that all strategies to improve adherence need to be investigated.…”