Lack of perceived benefit and inadequate transport influence uptake and completion of pulmonary rehabilitation in people with chronic obstructive pulmonary disease: a qualitative study

Question: What prevents people with chronic obstructive pulmonary disease (COPD) from attending and completing pulmonary rehabilitation programs?

Design: Qualitative design using semi-structured interviews.

Participants: 19 adults with COPD who had declined to participate and 18 adults with COPD who had not completed a pulmonary rehabilitation program at a metropolitan teaching hospital.

Results: A lack of perceived benefit from pulmonary rehabilitation was a significant theme for those who chose not to participate in pulmonary rehabilitation. Participants expressed perceptions that exercise was not a worthwhile treatment, or that they were already doing enough exercise at home. Difficulty getting to the program related to poor mobility, lack of transport, and cost of travel was a significant theme, expressed both by those who chose not to participate and those who did not complete. Another major theme associated with both uptake and completion involved being unwell, with participants indicating that the burden of COPD and other comorbidities impacted on attendance. Minor themes involved competing demands on time, older age, fatigue, program timing, and lack of social support.

Conclusion: Many people with COPD who elect not to take up a referral to pulmonary rehabilitation perceive that they would not experience any health benefits from attendance. Difficulties with travel to the program and being unwell are barriers to both uptake and completion. Improving attendance at pulmonary rehabilitation requires consideration of how information regarding the proven benefits of pulmonary rehabilitation can be conveyed to eligible patients, along with flexible program models that facilitate access and accommodate co-morbid disease.