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Introduction: Outpatient pulmonary rehabilitation (OPPR) provides patients with increased functional capacity and QOL. However, delineation of the factors related to successful completion of a prescribed course of OPPR has not been well studied.
Purpose: Therefore, a study was conducted to determine if baseline factors are related to successful OPPR completion (SC) and what the descriptors are for premature dropout (PDO).
Design: A non-experimental, retrospective, cross-sectional design was used.
Method: Patients were prescribed OPPR 3 times/week for 8 weeks (24 total sessions) in a supervised, hospital based program for 90 minutes/day, including a 45 minute upper body exercise/coordinated breathing class, a 45 minute exercise class utilizing treadmills and recumbent cycles, and education sessions. For the present study, program completion was defined as attendance of greater than 21 of 24 prescribed sessions. One hundred seventy-eight charts were reviewed for admission variables (age; BMI; % predicted FVC, FEV1, and DLCO; maximal oxygen consumption and VE/MVV by stress testing; resting SaO2; 6 minute walk time, distance and SaO2; SF36 scores; SOB score; MET level and duration of 1st session; and documented reasons for PDO).
Results: One hundred thirty-seven patients (80%) completed the program and 41 patients (20%) discontinued prior to the 21st session (SC = 23.9 +/- 0.5 vs PDO = 10.6 +/- 6.3 sessions). Independent t tests revealed no significant differences between the groups for any of the baseline variables except for the bodily pain subscale of the SF36 (SC = 67.4 +/- 27.8 vs PDO = 54.8 +/- 25.9; P = .023). Qualitatively, 11 categories were identified for PDO. There were 11 PDOs secondary to non-pulmonary related injury/illnesses (6.2%), 7 no reason given and lost to follow-up (3.9%), 5 secondary to the fatigue of chemotherapy (2.8%), 4 lower back pain (2.2%), 4 vacation/moved (2.2%), 3 transportation (1.7%), 3 insurance coverage (1.7%), 1 work issues (0.6%), 1 COPD exacerbation (0.6%), 1 not an appropriate candidate (0.6%), and 1 death (0.6%). Combining these categories into 4 major issues (1. Health = illness, injury, back pain, chemotherapy, exacerbations, death; 2. Programmatic = transportation, insurance, not appropriate candidate, work; 3. Non-programmatic = vacation, moved; 4. No Reason Given and Lost to Follow-up) revealed 22 Health related PDOs (12.4%), 8 Programmatic (4.5%), 7 No Reason Given and Lost to Follow-up (3.9%), and 4 Non-Programmatic (2.2%).
Conclusions: A majority (80%) of patients completed a 24 session OPPR program. Analyses demonstrated physiologic parameters are not predictive of successful OPPR completion, with the possible exception of the amount of bodily pain. Additionally, qualitative information regarding reasons for PDO show no obvious clustering that would lead to improved strategies for retention of patients.
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