Defining nonresponse to pulmonary rehabilitation by threshold scores for personality traits: a population-based study

Personality traits have been associated with the risk of nonresponse to therapeutic interventions such as pulmonary rehabilitation (PR). To optimise the tailoring of PR based on personality traits, this study aimed to extend existing knowledge on the relationship between personality traits and the risk of nonresponse to inpatient PR, and to define optimal threshold scores for personality traits to accurately predict nonresponse.

719 patients with chronic respiratory diseases were included across three centres in a multidisciplinary inpatient PR following international guidelines (M_duration =31 days). Personality traits were assessed at admission (T1). Clinical outcomes, including health-related quality of life, exercise capacity and dyspnoea, were measured at T1 and at discharge (T2). Nonresponse was defined as a change smaller than the established minimal clinically important difference for each outcome. Logistic regressions and receiver operating characteristic analyses were performed.

Controlling for sociodemographic and clinical covariates, higher neuroticism was associated with a higher risk of nonresponse to health-related quality of life (OR 1.35, 95% CI 1.10-1.65), whereas higher agreeableness was related to a lower risk (OR 0.80, 95% CI 0.65-0.98). No accurate threshold scores were identified (AUC_neuroticism=0.50).

Based on a large sample of patients with chronic respiratory diseases, this study shows that personality traits are associated with nonresponse to health-related quality of life in inpatient PR, suggesting continuous rather than threshold-based effects. Future studies should explore novel approaches to modify personality traits-linked response in PR, such as psychological strategies.