The Reasons for Non-Adherence in Pulmonary Rehabilitation Programs

Objective: Pulmonary Rehabilitation (PR), a multidisciplinary treatment modality, is recommended in management of COPD. Structure, experience of units /centers, contents of the program are as important as patient-specific factors.To our knowledge, there is no data regarding the success of PR in Turkey. This study was performed in order to determine the reasons for nonadherence in patients who underwent PR programs in Turkey.
Methods: Demographic data, initial assessment parameters of 143 patients were collected retrospectively, examined. Age, smoking history, FEV1%, health related quality of life, dyspnea score, body composition and psychological status of all patients who were divided into two group according to completion of PR were compared. The reasons of non-completion were asked from patients who did not complete PR by phone, their answers were recorded.
Results: Thirty two patients did not complete (22.3%) multidisciplinary, comprehensive, an individualized outpatient PR program.The most common reason for non-adherence except all medical conditions including exacerbations was inability to comprehend efficacy and contents of PR program. While mean walking distance of patients who completed PR was 241±128.9, other group’s distance was 183.4±119.9 m, endurance time was 7.03±6.32, 4.89±5.3 min (respectively, p=0.02). Although total SGRQ and all domains’ scores of patients who did not complete PR were higher, only impact domain scores, MRC scores were significantly higher (p=0.045, 0.01 respectively). Body composition, psychosocial status of patients did not differ significantly.
Conclusion: Patients with advanced dyspnea, decreased exercise capacity should be continuously, vigorously informed of possible gains in order to increase success rate of programs, adherence to programs should be reinforced by patient-specific individualized PR programs.