Obstructive Lung Diseases |

Profile of Patients Who Drop out of a Pulmonary Rehabilitation Program FREE TO VIEW

Virginia Almadana, PhD; Concepcion Romero, PhD; Agustin Valido, PhD; Ana Gómez-Bastero, PhD; Jesús Sánchez, PhD; Teodoro Montemayor, MD
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Macarena University Hospital, Sevilla, Spain

Chest. 2014;145(3_MeetingAbstracts):370A. doi:10.1378/chest.1788096
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SESSION TITLE: COPD Rehabilitation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Introduction: Despite the proven benefits of pulmonary rehabilitation programs (PR), these show a considerable drop-out and low attendance. Objectives: To identify the characteristics of patients with poor adherence to a specific COPD rehabilitation program.

METHODS: A prospective study of consecutive patients including COPD undergoing PR program in the last year (September 2011-12). - Inclusion criteria: COPD in any grade, symptomatic despite optimal treatment, ex-smokers (or cessation program). - Programme type: mixed (resistance exercise bike for 20 minutes and force (2S6R)) duration of 36 sessions, including chest physiotherapy and educational talks. - Accessibility is provided where necessary by ambulance for transport to the center.

RESULTS: N: 83 (Exclusion: 26 Abandonment: 22, complete program: 35). 38.5% dropout rate. -The reasons for exclusion of patients were refusing to go (13), unstable angina (1) mental illness (2), severe musculoskeletal disease (2), few symptoms (3), not attending screening tests performed ( 5). -The causes of discontinuation were: low motivation (8), family problems (1), transportation problems (4), enf. concomitant severe (3), death (3), trauma pathology (2), frequent exacerbations (1). -No significant differences were found between patients who leave the program and those who completed in general characteristics, quality of life questionnaires, comorbidities, six-minutes walk test, employment of OCD, NIV, CPAP, combination LABA + ICS or theophylline. Also there was also no difference in MRC dyspnea or BODE index. Statistical differences were founded in the use of systemic steroids (23,8 vs 2,9%, p 0,014), in stress test (submaximal (min) 6,2±2,1 vs 9,2±4,7, p 0,02 / maximun (w) 42,6±17,8 vs 56,5±22,7, p 0,03)

CONCLUSIONS: 1.The dropout rate was similar to that described in the literature (approximately 1 in 3). 2.The causes of abandonment of the program are variable, though poor motivation and transportation problems are the most common. 3.The patient profile leaving the program seems to be related to those in more impaired functional status (worst result in stress tests) and oral steroids.

CLINICAL IMPLICATIONS: It is necessary to improve adherence to PR programs, overall in those with worst status.

DISCLOSURE: The following authors have nothing to disclose: Virginia Almadana, Concepcion Romero, Agustin Valido, Ana Gómez-Bastero, Jesús Sánchez, Teodoro Montemayor

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