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Predictors of Outpatient Pulmonary Rehabilitation Uptake, Adherence, Completion, and Treatment Response Among Male U.S. Veterans With Chronic Obstructive Pulmonary Disease

Published:November 28, 2021DOI:https://doi.org/10.1016/j.apmr.2021.10.021

      Abstract

      Objective

      To examine predictors of uptake (never start), adherence (drop out), and completion of pulmonary rehabilitation (PR), as well as PR 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).

      Design

      Retrospective, cohort study.

      Setting

      Veterans Health Administration.

      Participants

      U.S. veterans with chronic obstructive pulmonary disease (COPD) (N=253) referred to PR between 2010 and 2018.

      Interventions

      Outpatient PR program.

      Main Outcome Measures

      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. Exercise capacity was assessed with the 6MWT. Participants who completed all 18 sessions of PR repeated assessments (time 2). Logistic regression models examined predictors of uptake, adherence, and completion of PR as well as treatment response based on MCID.

      Results

      Participants were referred to PR with 24.90% never starting, 28.90% dropping out, and 46.20% completing. No differences emerged between never starters and dropouts. Having a history of any cancer increased the likelihood of completing PR (vs never starting; odds ratio [OR], 3.18; P=.003). Greater CRQ-SR dyspnea score, indicating less dyspnea, was associated with increased likelihood of completing PR (OR, 1.12; P=.006). Past smoking compared with current smoking was associated with increased likelihood of completion (OR, 3.89; P≤.002). Those without a history of alcohol use disorder had increased likelihood of completing PR (OR, 2.23; P=.048). Greater baseline 6MWT distance was associated with lower likelihood of achieving MCID in 6MWT (OR, 0.99; P<.001). Greater Ex-SRES was associated with decreased likelihood of achieving 6MWT MCID (OR, 0.98; P=.023).

      Conclusions

      Findings suggest that early psychoeducation on dyspnea management and smoking and alcohol cessation may increase completion of PR.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), AUD (alcohol use disorder), COPD (chronic obstructive pulmonary disease), CRQ-SR (Chronic Respiratory Questionnaire–Self-Report), Ex-SRES (Exercise Self-Regulatory Efficacy Scale), FEV1 (forced expiratory volume in first second of expiration), FVC (forced vital capacity), MCID (minimal clinically important difference), mMRC (Modified Medical Research Council), OR (odds ratio), PR (pulmonary rehabilitation), PTSD (posttraumatic stress disorder), 6MWT (6-minute walk test), US (United States), VHA (Veterans Health Administration)
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