Factors associated with poor long-term adherence after completing a pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease
Affiliations: [a] Department of Respiratory Medicine, La Paz University Hospital, Madrid, Spain
| [b] Hospital La Paz Institute for Health Research (IdiPAZ), CIBERES, Autónoma University of Madrid, Madrid, Spain
| [c] Department of Pharmacy, La Paz University Hospital, Madrid, Spain
| [d] Department of Physical Medicine and Rehabilitation, La Paz University Hospital, Madrid, Spain
Correspondence:
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Address for correspondence: Pablo Mariscal Aguilar, Department of Respiratory Medicine, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, 28046, Spain. E-mail: pmaguilar91@gmail.com.
Abstract: BACKGROUND:Although pulmonary rehabilitation programmes (PRPs) benefit patients with chronic obstructive pulmonary disease (COPD), poor adherence to these programmes is common. OBJECTIVE:This study aimed to analyse the factors associated with poor long-term adherence after completing a PRP. METHOD:We conducted a retrospective study of 70 patients with COPD who performed an 8-week outpatient PRP that included 24 sessions of aerobic training, skeletal muscle resistance exercises, physiotherapy and COPD education. The study classified the patients into 2 groups: (1) long-term adherence and (2) long-term non-adherence to the PRP. We considered long-term non-adherence when the patient did not attend the 32 weeks follow-up visit after beginning the PRP. We measured the degree of dyspnoea, quality of life, physical activity, anxiety-depression status, submaximal exercise capacity and COPD exacerbations in both groups. RESULTS:The patients’ median age was 69.6 [63.8–75.0] years, and 71.4% were men. The median forced expiratory volume in 1 second was 60.0 [47.7–68.0] % of that predicted. We observed total COPD exacerbations and severe COPD exacerbations in the last year in 32 (45.7%) and 22 (31.4%) patients, respectively. Dyspnoea, physical activity and quality of life significantly improved after completing the PRP. Long-term non-adherence to the PRP was observed in 32 (45.7%) patients. In the single regression model, severe COPD exacerbations (p = 0.04) and dyspnoea (p = 0.03) were associated with long-term non-adherence to the PRP. In the multiple regression model, only severe COPD exacerbations remained as an associated factor (OR 2.7; 95% CI 1.1–8,1; p = 0.04). CONCLUSION:Approximately half of patients who complete PRPs present long-term non-adherence to the programme. Severe COPD exacerbations are associated with long-term non-adherence.
