Participation in pulmonary rehabilitation in routine clinical practice

Denmark offers COPD rehabilitation to enable patients to tackle the consequences of COPD, but only a minority of the patients complete these programs. To increase the completion rate, an follow-up study was performed, to characterize COPD patients and to identify potential differences between those who complete and those who do not complete rehabilitation or do not even get a rehabilitation offer in daily clinical routine.

In- and out COPD-patients who participated in baseline tests were compared in terms of completion of rehabilitation, drop-out, and no rehabilitation offer. We obtained data on basic characteristics, co-morbidity, lung-function (FEV1), dyspnea (MRC), six-minute walkg-distance (6MWD), and quality of life (SF36).

The source population counted 521 COPD patients of whom 256 were excluded (diagnosis withdrawn, death, moved away, long-term oxygen, severe illness). Patients who completed rehabilitation had a 15% longer 6MWD than patients not offered rehabilitation and a 10% longer 6MWD than drop-outs despite a significant lower subjective perception of physical function among completers than in the two other groups. Patients not offered rehabilitation had a slightly better lung function than the other two groups. This suggests that lower physical performance with the same (drop-outs) or even higher (not offered) lung function indicates a lower chance of completion.

COPD patients who could potentially benefit most from completing rehabilitation seem to be deselected. A mere 9% completed rehabilitation within the study period and 23% ever completed. This demonstrates that the political target that 60% of COPD patients should be offered rehabilitation is still far away.