Predictors of pulmonary rehabilitation completion in the UK

Philip W Stone; Katherine Hickman; Michael C Steiner; C Michael Roberts; Jennifer K Quint; Sally J Singh

doi:10.1183/23120541.00509-2020

Predictors of pulmonary rehabilitation completion in the UK

ERJ Open Res. 2021 Feb 8;7(1):00509-2020. doi: 10.1183/23120541.00509-2020. eCollection 2021 Jan.

Authors

Philip W Stone¹, Katherine Hickman², Michael C Steiner³, C Michael Roberts^{4

5

6}, Jennifer K Quint^{1

7}, Sally J Singh^{3

7}

Affiliations

¹ National Heart and Lung Institute, Imperial College London, London, UK.
² West Yorkshire and Harrogate Health and Care Partnership, Bradford, UK.
³ NIHR Leicester Respiratory Biomedical Research Centre, Dept of Respiratory Sciences, University of Leicester, Leicester, UK.
⁴ UCLPartners, London, UK.
⁵ Clinical Quality Improvement Dept, Royal College of Physicians, London, UK.
⁶ Institute of Population Health Sciences, Queen Mary University of London, London, UK.
⁷ These authors contributed equally.

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.