Respiratory rehabilitation in chronic obstructive pulmonary disease: predictors of nonadherence

Rehabilitation is now an integral part of chronic obstructive pulmonary dis ease (COPD) management. The objective of the study was to determine predict ors of nonadherence to a COPD rehabilitation programme. Patients attending a COPD clinic were invited to participate in a 4 week, h ospital-based, outpatient, COPD rehabilitation programme conducted predomin antly by respiratory physiotherapists. All potential participants undertook an interviewer administered questionnaire addressing social, economic, psy chological and healthcare factors, and underwent baseline physiological mea sures. Subsequently they were classified as: 1) "adherent" group who comple ted the total programme (n=55) or 2) "nonadherent" group who refused or beg an but did not complete the programme (n=36). The nonadherent group compared to the adherent group were more likely to be divorced (22 versus 2%, p<0.005), live alone (39 versus 14%, p<0.02), and to live in rented accommodation (31 versus 6%, p<0.005). There were no diff erences between the two groups in terms of baseline physiological parameter s (forced expiratory volume in one second, forced vital capacity, 6-min wal k distance, oxygen saturation, perceived dyspnoea), quality of life domains (Chronic Respiratory Disease Questionnaire), or indices of COPD-related mo rbidity. The nonadherent group were more likely to be current smokers (28 v ersus 8%, p<0.02) and less Likely to use inhaled corticosteroids (16 versus 42%, p<0.005). The nonadherent group was not significantly likely to be de pressed, anxious, prone to hyperventilation or to have had previous emotion al counselling and was more likely to be dissatisfied with disease-specific social support (51 versus 2%, p<0.001). In conclusion, a substantial proportion of eligible subjects who did not pa rticipate in a chronic obstructive pulmonary disease rehabilitation program me were not more physiologically impaired, but were more likely to be: soci ally isolated, lack chronic obstructive pulmonary disease-related social su pport, still be smoking and be less compliant with other healthcare activit ies. Identification of one or more of these factors reliably allows predict ion for nonadherence to a rehabilitation programme.