Pulmonary Rehabilitation in Clinical Routine -: A follow-up study of completers, dropouts and those who were not offered rehabilitation

Pulmonary Rehabilitation in Clinical Routine
- A follow-up study of completers, dropouts and those who were not offered rehabilitation

The effect of pulmonary rehabilitation has been amply documented in randomized controlled trials (RCTs). A Cochrane review and international guidelines recommend rehabilitation as an important part of the care for COPD patients. Danish COPD-rehabilitation programs have been implemented based on these recommendations. Knowledge of completion rates and effects are important when this is implemented to a broad COPD-population as clinical routine rehabilitation (CRR).

We aimed to characterize a COPD-cohort treated at Regional Hospital in Denmark and to study changes in rehabilitation outcomes; walk-distance (6MWD), quality of life (QoL), and dyspnoea (MRC score).
We hypothesized that completers of CRR would improve these outcomes and that their basic characteristics would predict completion.
Materials and methods: Participants in follow-up were in- and outpatients with COPD. CRR completers were compared with drop-outs, those who had previously completed CRR, and those with no CRR offer. We compared changes in MRC, 6MWD, and QoL (SF36) from baseline to follow-up at 3, 6, and 12 months.
Result:
From the source population of 521 patients, 148 participated in follow-up.
The patients were in their late sixties, short educated, half of the patients current smokers approx. half of the patients tested positive for depression. More than 80 had at one or more co-morbidities with no differences between completers of CCR and non-completers and their characteristics did not predict completion.
Completers did not improve in 6MWD from baseline to the end of rehabilitation and had declined at the 12-month follow-up. MRC and QoL did not improve. Completers` attitudes toward rehabilitation were positive: 75% felt better or much better after rehabilitation.

Conclusion
Completers of CRR did not improve in core rehabilitation outcomes. One explanation is that, they differ from the study-populations in RCTs. A CRR-program based on current guidelines may not work in clinical routine because the broad COPD-population treated at a regional hospital in Denmark probably differ fundamentally from RCT participants in terms of their ability to change life stile and follow instructions. Second, the CRR offered may not match the RCTs in terms of the quality of its contents and the methods used to monitor and ascertain improvement in a non-experimental clinical setting.
More knowledge is needed on the effects of rehabilitation in relation to individual monitoring and quality control during rehabilitation in contexts where CRR targets broad COPD populations.

Keywords: COPD; completing; dropout; outcome; rehabilitation; selection;