What to do before pulmonary rehabilitation to improve adherence?

Pulmonary rehabilitation reduces daily symptoms and improves functional exercise performance and health status in patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Moreover, post-exacerbation pulmonary rehabilitation in COPD can reduce re-exacerbation events that require admission or hospital attendance over a 3-month period. Consequently, pulmonary rehabilitation is recommended to be integrated in the management of symptomatic patients with COPD. Even though pulmonary rehabilitation can be considered a beneficial non-pharmacological intervention for patients with COPD, a considerable proportion of the COPD patients who have been referred for pulmonary rehabilitation decline participation. For example, Young et al. reported a decline rate of 34% of the initial group of 88 COPD patients referred for pulmonary rehabilitation. The main reasons given by the patients for non-participation included work commitments, transport difficulties, considered themselves to be too ill, considered the programme to be too difficult, considered the programme unlikely to be helpful and ‘other reasons. ’ Similar reasons are reported for drop out during a pulmonary rehabilitation programme. So, medical specialists referring COPD patients for pulmonary rehabilitation should ensure that individual patients’ information needs about various aspects in pulmonary rehabilitation are adequately met. Key aspects include individualizing information concerning transportation difficulties, health care costs, service provision (setting and timing of the program), the content of the program, the burden of the program, the importance of the program and possible communication difficulties. For patients with work commitments, pulmonary rehabilitation programs may be offered out of working hours. Moreover, for patients with transportation difficulties, community transportation needs to be arranged to the rehabilitation centre or pulmonary rehabilitation programs should be offered in health care facilities near the patients’ home. Indeed, specialised rehabilitation centres can increase their capacity by sharing their knowledge with general hospitals through decentralization, including resource allocation, which will provide an appropriate response to the increasing interest in pulmonary rehabilitation for disabled patients with COPD. Also pre-rehabilitation instruction videos on the internet may be considered an appropriate and low-threshold tool. For example, colleagues from Imperial College (London, United Kingdom) provide information on pulmonary rehabilitation via www.youtube. com (search terms: ‘copd AND rehabilitation’). Nevertheless, the internet does not specifically address the individual needs of COPD patients that have been referred for pulmonary rehabilitation. Indeed, a pre-rehabilitation face-to-face contact may be necessary to address the individual needs and problems that patients with COPD may experience before the start of a pulmonary rehabilitation program. In the current issue of Chronic Respiratory Disease, Graves et al. report the effects of a ‘group optin session’ on the uptake and graduation rates for a pulmonary rehabilitation program for patients with COPD. COPD patients referred for pulmonary rehabilitation were invited to attend a 1.5-hours group optin session run by psychologist and physiotherapist. The concept of pulmonary rehabilitation was introduced in a supportive environment using a case study of a patient with COPD. Moreover, the pulmonary rehabilitation course was discussed in detail. Indeed, reasons for individual unsuitability for the pulmonary