Pulmonary rehabilitation (PR) is a beneficial treatment for patients with chronic obstructive pulmonary disease (COPD). Our aims were to define the patients’ adherence impact on PR outcomes and to prognosticate patients’ compliance. Since smoking cessation is the most difficult task to comply, we hypothesized that quitters are those who are expected to comply to PR as well.
Adherence was set according to patients’ attendance in a 25-session PR program. We investigated whether the level of adherence determines the magnitude of the improvement in dyspnea (MRC scale), exercise capacity (6-min walking distance, 6MWD)and quality of life (St. George's Respiratory Questionnaire, SGRQ). Furthermore, we evaluated patients’ motivation by their smoking history and nicotine addiction (Fagerstrom scale, FS). We considered as highly motivated patients (HMP) the persistent quitters despite their severe nicotine addiction (FS 7–10), while patients who continue smoking despite their mild-to-moderate nicotine addiction (FS 0–6) were considered as the less motivated patients (LMP).
Eighty five consecutive COPD outpatients were stratified into 2 groups: Group A (48 patients attended 18–25 sessions) and Group B (37 patients attended 10–17 sessions). Group A patients presented significant improvements, in dyspnea (Group A: MRC from 3.9±0.4 to 2.8±0.5; Group B: from 3.8±0.6 to 3.2±0.6; p<0.05), in 6MWD (Group A: from 247±32 to 339±41 m; Group B: from 254±40 to 312±36 m; p<0.01) and in SGRQ (Group A: from 59±11 to 39±14; Group B: from 55±13 to 46±15; p<0.01). Furthermore, 2 subgroups of 22 and 25 patients fell into HMP and LMP categorization respectively. The HMP group attended 23±2 sessions, while the patients of LMP group attended only 13±3 sessions (p<0.05).
Adherence to PR determines significantly the effects of PR on dyspnea, exercise capacity and quality of life. Combined assessment of smoking history and nicotine addiction seems a useful test of motivation to prognosticate the level of adherence.
Given that PR has limited availability, the use of an easy-to-use test to prognose the patient's adherence to PR is challenging.
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