Assessing inpatient pulmonary rehabilitation using the patient's view of outcome

Assessment of the patient's view of outcome should complement standardized evaluation methods, especially in multi-intervention rehabilitation programs. Assessment of individualized outcomes has not been used previously in pulmonary rehabilitation studies. Therefore, the authors developed a method for assessing the patient's view of outcome.

Patients and their therapists scored the subjective attainment level of individualized treatment goals on a 6-point response scale. Mean attainment scores, sensitivity to change, reliability, and validity were computed.

The study found that 79 patients (20 with asthma and 59 with chronic obstructive pulmonary disease) who participated in an inpatient pulmonary rehabilitation program had 540 treatment goals (range 2-12 goals per patient). The patients had a significantly higher median attainment score than the main therapists (5 versus 4; n = 286; P <.0001). Sensitivity to change of the attainment scores from patients was very high. The patients (n = 42) had a standardized response mean of 3.57 for the attainment scores, as compared to 1.01 for the total score of the Quality of Life for Respiratory Illness Questionnaire. Attainment scores of treatment goals with at least 10 occurrences were significantly correlated with closely related external outcomes. Interrater agreements between patients and therapists as well as among therapists were low (weighted kappa < 0.35).

The patient's view was used to describe the outcome of inpatient pulmonary rehabilitation. Attainment scoring has a high sensitivity to change and a satisfying validity. The low reliability between the individual's point of view and that of the therapist necessitates a clear description for the different levels of expected outcome. The individualized goal attainment method seems to be a promising complementary way of evaluating pulmonary rehabilitation.