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Oates GR, Hamby BW, Stepanikova I, Knight SJ, Bhatt SP, Hitchcock J, Schumann C, Dransfield MT. Social Determinants of Adherence to Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease. COPD 2017; 14:610-617. [PMID: 29020525 DOI: 10.1080/15412555.2017.1379070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adherence to pulmonary rehabilitation (PR) is low. Previous studies have focused on clinical predictors of PR completion. We aimed to identify social determinants of adherence to PR. A cross-sectional analysis of a database of COPD patients (N = 455) in an outpatient PR program was performed. Adherence, a ratio of attended-to-prescribed sessions, was coded as low (<35%), moderate (35-85%), and high (>85%). Individual-level measures included age, sex, race, BMI, smoking status, pack-years, baseline 6-minute walk distance (6MWD: <150, 150-249, ≥250), co-morbidities, depression, and prescribed PR sessions (≤20, 21-30, >30). Fifteen area-level measures aggregated to Census tracts were obtained from the U.S. Census after geocoding patients' addresses. Using exploratory factor analysis, a neighborhood socioeconomic disadvantage index was constructed, which included variables with factor loading >0.5: poverty, public assistance, households without vehicles, cost burden, unemployment, and minority population. Multivariate regression models were adjusted for clustering on Census tracts. Twenty-six percent of patients had low adherence, 23% were moderately adherent, 51% were highly adherent. In the best fitted full model, each decile increase in neighborhood socioeconomic disadvantage increased the risk of moderate vs high adherence by 14% (p < 0.01). Smoking tripled the relative risk of low adherence (p < 0.01), while each increase in 6MWD category decreased that risk by 72% (p < 0.01) and 84% (p < 0.001), respectively. These findings show that, relative to high adherence, low adherence is associated with limited functional capacity and current smoking, while moderate adherence is associated with socioeconomic disadvantage. The distinction highlights different pathways to suboptimal adherence and calls for tailored intervention approaches.
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Affiliation(s)
- Gabriela R Oates
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Bryant W Hamby
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Irena Stepanikova
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sara J Knight
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.,c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA
| | - Surya P Bhatt
- d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jason Hitchcock
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Christopher Schumann
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mark T Dransfield
- c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA.,d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
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Jones AW, Taylor A, Gowler H, O'Kelly N, Ghosh S, Bridle C. Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD. ERJ Open Res 2017; 3:00089-2016. [PMID: 28154821 PMCID: PMC5279070 DOI: 10.1183/23120541.00089-2016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/06/2016] [Indexed: 12/22/2022] Open
Abstract
Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD.
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Affiliation(s)
- Arwel W Jones
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Abigail Taylor
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Holly Gowler
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Noel O'Kelly
- Community Health Services, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Sudip Ghosh
- Community Health Services, Leicestershire Partnership NHS Trust, Leicester, UK; Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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Johnston CL, Maxwell LJ, Alison JA. Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals. Aust J Rural Health 2015; 24:106-14. [PMID: 26010050 DOI: 10.1111/ajr.12202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. SETTING Rural (NSW) and remote (NT) Australian healthcare settings. PARTICIPANTS Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation. MAIN OUTCOME MEASURE(S) Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. RESULTS Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. CONCLUSIONS Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.
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Affiliation(s)
- Catherine L Johnston
- Discipline of Physiotherapy, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal J Maxwell
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Jennifer A Alison
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Russo R, Coultas D, Ashmore J, Peoples J, Sloan J, Jackson BE, Uhm M, Singh KP, Blair SN, Bae S. Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): results of recruitment and baseline patient characteristics. Contemp Clin Trials 2015; 41:192-201. [PMID: 25657053 PMCID: PMC4380855 DOI: 10.1016/j.cct.2015.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe the recruitment methods, study participation rate, and baseline characteristics of a representative sample of outpatients with COPD eligible for pulmonary rehabilitation participating in a trial of a lifestyle behavioral intervention to increase physical activity. SETTING AND DESIGN A patient registry was developed for recruitment using an administrative database from primary care and specialty clinics of an academic medical center in northeast Texas for a parallel group randomized trial. RESULTS The registry was comprised of 5582 patients and over the course of the 30 month recruitment period 325 patients were enrolled for an overall study participation rate of 35.1%. After a 6-week COPD self-management education period provided to all enrolled patients, 305 patients were randomized into either usual care (UC; n=156) or the physical activity self-management intervention (PASM; n=149). There were no clinically significant differences in demographics, clinical characteristics, or health status indicators between the randomized groups. CONCLUSION The results of this recruitment process demonstrate the successful use of a patient registry for enrolling a representative sample of outpatients eligible for pulmonary rehabilitation with COPD from primary and specialty care. Moreover, this approach to patient recruitment provides a model for future studies utilizing administrative databases and electronic health records.
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Affiliation(s)
- Rennie Russo
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - David Coultas
- Veterans Administration Portland Healthcare System and Oregon Health Science University, Department of Medicine, Portland, OR, United States.
| | - Jamile Ashmore
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States; Baylor Medical Center, Behavioral Health Center, Plano, TX, United States
| | - Jennifer Peoples
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - John Sloan
- University of Texas at Tyler, Department of Health and Kinesiology, Tyler, TX, United States
| | - Bradford E Jackson
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
| | - Minyong Uhm
- University of Texas Health Sciences Center at Tyler, Department of Medicine, Tyler, TX, United States
| | - Karan P Singh
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
| | - Steven N Blair
- University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Sejong Bae
- University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, United States
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Sohanpal R, Hooper R, Hames R, Priebe S, Taylor S. Reporting participation rates in studies of non-pharmacological interventions for patients with chronic obstructive pulmonary disease: a systematic review. Syst Rev 2012; 1:66. [PMID: 23272768 PMCID: PMC3563605 DOI: 10.1186/2046-4053-1-66] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/26/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) and self-management (SM) support programmes are effective in the management of patients with chronic obstructive pulmonary disease (COPD), but these interventions are not widely implemented in routine care. One reason may be poor patient participation and retention. We conducted a systematic review to determine a true estimate of participation and dropout rates in research studies of these interventions. METHODS Studies were identified from eight electronic databases including MEDLINE, UK Clinical Trial Register, Cochrane library, and reference lists of identified studies. Controlled clinical trial studies of structured SM, PR and health education (HE) programmes for COPD were included. Data extraction included 'participant flow' data using the Consolidated Standards of Reporting Trials (CONSORT) statement and its extension to pragmatic trials. Patient 'participation rates' (study participation rate (SPR), study dropout rate (SDR) and intervention dropout rate (IDR)) were calculated using prior participation definitions consistent with CONSORT. Random effects logistic regression analysis was conducted to examine effects of four key study characteristics (group vs. individual treatment, year of publication, study quality and exercise vs. non-exercise) on participation rates. RESULTS Fifty-six quantitative studies (51 randomised controlled trials, three quasi-experimental and two before-after studies) evaluated PR (n = 31), SM (n = 21) and HE (n = 4). Reports of participant flow were generally incomplete; 'numbers of potential participants identified' were only available for 16%, and 'numbers assessed for eligibility' for only 39% of studies. Although 'numbers eligible' were better reported (77%), we were unable to calculate SPR for 23% of studies. Overall we found 'participation rates' for studies (n = 43) were higher than previous reports; only 19% of studies had less than 50% SPR and just over one-third (34%) had a SPR of 100%; SDR and IDR were less than or equal to 30% for around 93% of studies. There was no evidence of effects of study characteristics on participation rates. CONCLUSION Unlike previous reports, we found high participation and low dropout rates in studies of PR or SM support for COPD. Previous studies adopted different participation definitions; some reported proportions without stating definitions clearly, obscuring whether proportions referred to the study or the intervention. Clear, uniform definitions of patient participation in studies are needed to better inform the wider implementation of effective interventions.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
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van Gestel AJ, Kohler M, Steier J, Sommerwerck U, Teschler S, Russi EW, Teschler H. Cardiac Autonomic Function and Cardiovascular Response to Exercise in Patients with Chronic Obstructive Pulmonary Disease. COPD 2012; 9:160-5. [DOI: 10.3109/15412555.2011.647130] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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