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Predictors of premature discontinuation and prevalence of dropouts from a pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease

Published:January 20, 2022DOI:https://doi.org/10.1016/j.rmed.2022.106742

      Highlights

      • One in four COPD patients did not complete a pulmonary rehabilitation (PR) program.
      • Elevated anxiety and dyspnea were predictors of early dropout of PR.
      • Younger age and reduced exercise capacity were associated with dropout from PR.
      • Intensive strategies are needed to support and adherence at the start of PR program.

      Abstract

      Introduction

      To date, very little is known about the risk factors that contribute to premature discontinuation (dropout) from pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). We examined prevalence and predictors of premature discontinuation in patients who participated in an eight week PR program.

      Methods

      We analyzed a prospectively maintained data-base of patients with COPD who attended a PR program from 2013 to 2019. We included patients 40 years or older with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio less than 0.7. Subjects were assigned completers or non-completers based on whether they completed the 8-week PR program. Quality of life was measured using the St-George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT).

      Results

      Nine hundred nighty three COPD patients (mean age = 70.82 years, FEV1 = 59.21% predicted, 51% male) entered the PR program. Of these, 259 (26%) discontinued PR prematurely and 139 (53%) were male. Compared with completers, non-completers had elevated symptoms of dyspnea and anxiety, had reduced exercise tolerance, were younger, and had poorer quality of life at entry (all p < 0.05). On multivariate analysis, the following variables were independently associated with discontinuation from PR: younger age (p < 0.001), elevated symptoms of anxiety (p < 0.001), elevated symptoms of dyspnea (p < 0.01) and reduced exercise tolerance (p < 0.002).

      Conclusion

      Over a quarter of COPD patients discontinued the PR program prematurely. Discontinuation of PR was associated with younger age, elevated symptoms of dyspnea and anxiety, and reduced exercise capacity, but not with severity of airflow obstruction.

      Keywords

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