S26 Barriers to attendance and adherence at pulmonary rehabilitation

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Abstract

Background

Pulmonary rehabilitation (PR) is a multidisciplinary programme which has been shown to improve symptoms and exercise tolerance in patients with COPD and is recommended by national guidelines. Attendance at pulmonary rehabilitation following referral is low and many patients drop-out of the programme before completion. The aim of this study is to obtain quantitative data to assess predictors of attendance and adherence at PR.

Methods

We performed a retrospective analysis of a database of patients with COPD, who had been invited to attend a pulmonary rehabilitation programme over a 5-year period. Data was obtained from 727 patients. Patients were divided into three groups based on the number of sessions attended; non-attendance (0% attendance), non-adherence (1%–63% attendance), adherence (>63% attendance). Data were compared between attenders vs non-attenders and adherers vs non-adherers to identify predictors (Gender, Smoking status, pack years, cohabitation, referral route, employment status, body mass index, forced expiratory volume in 1 s (FEV1), FEV1% predicted, oxygen therapy (LTOT), oxygen saturations at rest, lung information needs questionnaire*, shuttle walk distance*, previous hospitalisation and year of referral) of attendance and adherence to be identified. *Included in adherence analysis only.

Results

31.8% of patients referred for PR did not attend and a further 28.3% were non-adherent. Univariate predictors of attendance were male gender (OR=1.53 95% CI (1.05 to 2.25)), cohabitation (1.77 (1.17 to 2.67)) ex-smoker (2.29 (1.50 to 3.50)). Predictors of adherence were age (64–70: OR 1.99 (1.20 to 3.30); 71–76: 2.57 (1.48 to 4.45)) ex-smoker (4.86 (3.18 to 7.41)), FEV1 (higher more likely), FEV1% predicted (higher more likely), LTOT (0.54 (0.30 to 0.96)). Multiple logistic regression revealed that LTOT (OR 0.39 (0.18 to 0.84)) and cohabitation (1.84 (1.03 to 3.30)) were independent predictors of attendance. Multiple logistic regression revealed that only ex-smoker was predictive of adherence (OR 5.68 (3.33 to 9.7)).

Discussion

This large quantitative study has reaffirmed previous smaller observations regarding attendance at pulmonary rehabilitation. Disease severity and lack of potential supportive partner also has a negative impact on attendance. Smoking status appears to be a strong factor in predicting attendance and adherence to sessions. Contrary to previous observations, we found no association between type of professional referring and attendance at pulmonary rehabilitation.

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