Abstract
Introduction: Pulmonary rehabilitation is the most effective COPD treatment in improving quality of life. Access to PR is variable and rates of completion are relatively low at 35%. In this study of an integrated system-wide PR service we report on outcome, referral rates, and predictors of attendance and completion.
Method: Routine data were gathered prospectively on demography, rolling or stand alone courses, spirometry, walking distance, quality of life, BMI, and referrer, in patients referred for PR between April 2008 and October 2010. Predictors of attendance and course completion were sought using multiple regression.
Results: 1563 patients were referred, 1117 attended for assessment and 593 (38%) completed a PR course. Referred patients were of similar age and sex as the COPD population from which they were referred but were more severely affected. All PR programme types showed significant improvements in walking distance and quality of life, reaching the minimum clinically important difference. Twice weekly courses were more effective. Patients who were depressed (OR 0.75, CI 0.63-0.90), had a higher MRC dyspnea score (OR 00.76, CI 0.63-0.91), were from lower socio-economic groups (OR 0.98,CI 0.97-0.99), or were referred by GPs (OR 0.57, CI 0.35-0.94) were less likely to complete courses. Drop-out was not affected by venue, once or twice weekly courses, or rolling or stand-alone programmes.
Conclusions: Pulmonary rehabilitation is effective in real-world clinical practice achieving results comparable to clinical trials. We have identified patients in whom special intervention may be required to overcome the obstacles that place them at greater risk of not completing PR.
- © 2011 ERS