BOSTON — Which veterans with chronic obstructive pulmonary disease are likely to participate in and complete a pulmonary rehabilitation program?
A study from the VA New England Geriatric Research Education and Clinical Center (GRECC) at the VA Boston Healthcare System and Harvard Medical School sought to answer that question. The report in Archives of Physical Medicine and Rehabilitation discussed how researchers examined predictors of uptake (never start), adherence (drop out) and completion of pulmonary rehabilitation (PR). The article also included information on pulmonary rehabilitation treatment response based on minimal clinically important difference (MCID) on the 6-minute walk test (6MWT) distance and Chronic Respiratory Questionnaire-Self-Report (CRQ-SR).1
The retrospective, cohort study involved 253 VHA patients with COPD referred to PR between 2010 and 2018.
As part of the research, participants completed baseline (time 1) measures of depression (Beck Depression Inventory-II), health-related quality of life (CRQ-SR), self-efficacy (Exercise Self-Regulatory Efficacy Scale [Ex-SRES]), and COPD knowledge. The study team assessed exercise capacity with the 6MWT. Participants who completed all 18 sessions of PR repeated assessments (time 2), while models examined predictors of uptake, adherence, and completion of PR as well as treatment response based on MCID.
Of the participants referred to PR, 24.90% never started, 28.90% dropped and 46.20% completed the program. Researchers determined no differences between never starters and dropouts.
Other factors had some significance, however. The study found that having a history of any cancer increased the likelihood of completing PR (vs never starting; odds ratio [OR], 3.18; P=0.003). Increased likelihood of completing rehab was associated with greater CRQ-SR dyspnea score, indicating less dyspnea, (OR, 1.12; P=0.006). In addition, past smoking compared with current smoking was associated with increased likelihood of completion (OR, 3.89; P≤0.002), as did no history of alcohol use disorder (OR, 2.23; P=0.048).
On the other hand, greater baseline 6MWT distance was associated with lower likelihood of achieving MCID in 6MWT (OR, 0.99; P<0.001), which greater Ex-SRES was associated with decreased likelihood of achieving 6MWT MCID (OR, 0.98; P=0.023).
“Findings suggest that early psychoeducation on dyspnea management and smoking and alcohol cessation may increase completion of PR,” the researchers concluded.
- Bamonti PM, Boyle JT, Goodwin CL, Wan ES, Silberbogen AK, Finer EB, Moy ML. Predictors of Outpatient Pulmonary Rehabilitation Uptake, Adherence, Completion, and Treatment Response Among Male U.S. Veterans With Chronic Obstructive Pulmonary Disease. Arch Phys Med Rehabil. 2021 Nov 29:S0003-9993(21)01573-2. doi: 10.1016/j.apmr.2021.10.021. Epub ahead of print. PMID: 34856155.