Predictors of pulmonary rehabilitation completion in the UK

Abstract

Introduction: Pulmonary rehabilitation has been shown to improve dyspnoea, fatigue, quality of life and exercise capacity in individuals with chronic obstructive pulmonary disease (COPD). Our aim was to determine the characteristics of people with COPD associated with completion of pulmonary rehabilitation.

Methods: This was a cross-sectional analysis of 7060 people with COPD enrolled in pulmonary rehabilitation between January 1, 2017 and March 31, 2017. Data were from a UK national audit of COPD care. Factors associated with pulmonary rehabilitation completion were determined using mixed effects logistic regression with a random intercept for pulmonary rehabilitation service. Factors chosen for assessment based on clinical judgement and data availability were age, sex, country, socioeconomic status, body mass index, referral location, programme type, start within 90 days, smoking status, oxygen therapy, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) dyspnoea grade, any exercise test and any health status questionnaire.

Results: 4635 (66%) people with COPD completed a pulmonary rehabilitation programme. People that were aged ≥60 years, resident in Wales, referred within 90 days, an ex- or never-smoker, received an exercise test, or received a health status questionnaire had significantly greater odds of completing pulmonary rehabilitation. People that were in the most deprived quintile, underweight or very severely obese, enrolled in a rolling rather than a cohort programme, had a higher GOLD stage and had a higher MRC grade had significantly lower odds of completing pulmonary rehabilitation.

Conclusions: People with COPD were more likely to complete pulmonary rehabilitation when best practice guidelines were followed. People with more severe COPD symptoms and those enrolled in rolling rather than cohort programmes were less likely to complete pulmonary rehabilitation. Referring people with COPD in the earlier stages of disease, ensuring programmes follow best practice guidelines and favouring cohort over rolling programmes could improve rates of pulmonary rehabilitation completion.

Conflict of interest statement

Conflict of interest: P.W. Stone reports that he is part of the analysis team for the National Asthma and COPD Audit Programme and his university receives funding for that from the Royal College of Physicians. Conflict of interest: K. Hickman has nothing to disclose. Conflict of interest: M.C. Steiner reports advisory board fees from GlaxoSmithKline and nonfinancial support for travel to an international conference from Boehringer Ingelheim, outside the submitted work. Conflict of interest: C.M. Roberts reports personal fees from AstraZeneca and Pfizer for nonpromotional educational seminars for primary care staff on the relevance of audit findings, outside the submitted work. Conflict of interest: J.K. Quint reports that she is the analysis lead for the National Asthma and COPD Audit Programme and her university receives funding for that from the Royal College of Physicians; and grants and personal fees from AstraZeneca, Bayer, Boehringer Ingelheim, Chiesi and GlaxoSmithKline, and grants from the Medical Research Council and The Health Foundation, outside the submitted work. Conflict of interest: S.J. Singh has nothing to disclose.

Copyright ©ERS 2021.

Figures

FIGURE 1

Plot showing mutually adjusted odds ratios for completion of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients that enrolled in a pulmonary rehabilitation programme by patient characteristics. BMI: body mass index; GOLD: Global Initiative for Chronic Obstructive Lung Disease; MRC: Medical Research Council; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walk test; 6MWT: 6-min walk test; SGRQ: St George's Respiratory Questionnaire; CRQ: Chronic Respiratory Questionnaire; CAT: COPD Assessment Test.