Elsevier

Respiratory Medicine

Volume 103, Issue 10, October 2009, Pages 1564-1571
Respiratory Medicine

Drop-out and attendance in pulmonary rehabilitation: The role of clinical and psychosocial variables

https://doi.org/10.1016/j.rmed.2008.11.020Get rights and content
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Summary

Background

In spite of the well-demonstrated benefits for patients with COPD, pulmonary rehabilitation programmes show considerable drop-out and suboptimal attendance rates. The purpose of this prospective study is to examine causes for drop-out and non-attendance during a 12 week multidisciplinary pulmonary rehabilitation programme, and to investigate whether sociodemographic and medical factors as well as patients’ perception of their illness are related to drop-out and non-attendance.

Methods

Two hundred and seventeen patients with COPD who were referred to a rehabilitation centre participated in this multicentre study. Prior to treatment, patients received a questionnaire, which included the Illness Perception Questionnaire-Revised. Clinical data were drawn from medical records. Drop-out and attendance were recorded during the programme.

Results

Fifty patients (23%) did not complete the rehabilitation course, of which half was due to medical reasons (e.g. exacerbations, hospitalisations). Non-completion could not be predicted by baseline sociodemographic, clinical or psychological variables. Patients who declined treatment did not differ from patients who dropped out due to medical reasons. On average, patients attended 92% of all scheduled appointments. Of all missed appointments, approximately 20% were accountable to factors beyond patients’ control (e.g. absent therapists, hospitalisations). Smoking, living alone, a lower fat free mass and lower confidence in treatment increased the chance of patients not attending an appointment during rehabilitation.

Conclusion

In general, adherence in rehabilitation is high. However, paying attention to patients’ nutritional status and creating a positive expectation of treatment during referral and intake appear to be important if one aims to optimise patients’ attendance during rehabilitation.

Keywords

Attendance
Chronic obstructive pulmonary disease
Drop-out
Illness perceptions
Pulmonary rehabilitation

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