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Yohannes A.M.1, Dryden S.2, Hanania N.3
1Manchester Metropolitan University, Health Professions, Manchester, United Kingdom, 2St. Annes Primary Care Center, Blackpool, United Kingdom, 3Baylor College of Medicine, Section of Pulmonary and Critical Care Medicine, Houston, United States
Background: Pulmonary rehabilitation improves exercise capacity, quality of life, reduces dyspnoea and hospital readmissions in patients with chronic obstructive pulmonary disease (COPD). Studies have reported that twenty to forty five percent of COPD patients do not complete pulmonary rehabilitation program and costly to the healthcare service.
Purpose: Little is known about sex differences in terms of COPD patients' dropout of pulmonary rehabilitation program. We examined if there were differences in sex in non-completion versus completion of COPD patients' of the eight-week pulmonary rehabilitation (PR) program.
Methods: We have prospectively collected baseline data of patients with COPD who participated in eight-week PR. The PR programme was once a week for two hours, which (combined of circuit aerobic exercise therapy and muscle strengthening exercises) for eight weeks.The educational components of the programme consist of nutrition, relaxation therapy, counselling and managing inhalers. Inclusion: COPD patients referred to PR program by general practitioners and respiratory consultants. Exclusion: COPD patients with unstable angina and exercise intolerance. Pre and post-rehabilitation outcome measures were examined: exercise capacity was assessed by incremental shuttle walk test (ISWT), quality of life measured using the St-Georges Respiratory Questionnaire (SGRQ), and severity of dyspnoea was assessed using the Medical Research Council scale. Depression was assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Completion was defined as attending 75% of the designated PR schedules and completed the eight weeks evaluation.
Data analysis: Differences between means were examined using t-test, prevalence of dropout of COPD patients from PR in terms of sex using a Chi-square test. Predictors of non-completion versus completion of PR as dependent variable were examined using the logistic regression analysis. Significance was set at p 0.05.
Results: Four hundred forty one COPD patients were recruited into community-based PR program. Mean age (SD) completers versus non-completers [71.5(8.82) versus 69.2 (10.23), t = 2.29, p=0.02]. 327 (74%) COPD patients completed the eight weeks PR program. Twenty-six percent of COPD patients did not complete PR program. Significantly more women than men did not complete PR (χ2= 3.75, p 0.05). Logistic regression analysis showed that high load of depressive symptoms odds ratio (95% CI) -0.96 (0.94 0.98), p 0.001 and high level of dyspnoea symptoms odds ratio (95% CI) -0.80 (0.66 0.98), p 0.03 and female sex were less likely to complete the PR program with odds ratio (95% CI) 0.95 (0.90 0.98), p 0.01). Age and lung function were not associated to non-completion of PR.
Conclusion(s): · Twenty six percent of COPD patients did not complete the PR program.
· Patients with COPD with high load of depressive and dyspnoea symptoms and female sex are less likely to complete the PR program.
· Prospective well-controlled trials are needed with strategies that improve adherence and completion of PR program.
Implications: · Therapists should consider targeted intervention to treat depression in patients with COPD during PR program.
· Greater effort should be made to support and encourage women to complete PR using the available technology e.g. in a weekly telephone call or sending reminders of text messages.
Funding acknowledgements: No funding was received to conduct this study.
Topic: Cardiorespiratory
Ethics approval: The study was approved by the research ethics committee of the Blackpool Teaching Hospital Foundation National Health Service Trust (Ref:SE/0390).
All authors, affiliations and abstracts have been published as submitted.
