Performance-based criteria are used in participant selection for pulmonary rehabilitation programs
Authors: Walsh James R. , McKeough Zoe J. , Morris Norman R. , Paratz Jenny D. 
Published: April 2013

Objective
To determine the participant entry criteria used by Australian-based pulmonary rehabilitation programs and the factors that influence selection.

Methods
This cross-sectional observational study invited all program coordinators listed on the Australian Lung Foundation’s pulmonary rehabilitation database in November 2009.

Results
The response rate was 40.5% (79/195), with 58% of respondents reporting a waiting list. Forty respondents reported prioritising referrals due to: disease severity (75%), requirement for medical procedure (70%), upon medical request (60%) or participant’s likelihood to benefit (55%). Fifty-eight respondents reported using entry criteria to select participants, which was mainly for safety reasons and performance-based expectations. All 58 respondents used at least one exclusion criterion in selecting their participants, compared with only 25 programs using inclusion criteria. Increased demand on individual programs was related to prioritising referrals (P < 0.001) and was reported by 12 programs as a reason for using participant entry criteria.

Conclusions
Program coordinators commonly prioritise referrals and use participant entry criteria to manage clinical demand with performance-based expectations an important consideration. The inclusion criteria that identify participants more likely to benefit from pulmonary rehabilitation are less commonly used in the performance-based selections.

What is known about the topic?
Pulmonary rehabilitation is an essential component of chronic lung disease management due to the high-quality evidence demonstrating that these programs can improve participants’ exercise capacity, dyspnea and quality of life. However, access to pulmonary rehabilitation is severely limited in Australia with <1% of individuals with moderate to severe chronic obstructive pulmonary disease able to participate in these programs each year. Prior to the present study it was unknown how Australian pulmonary rehabilitation coordinators manage this demand on their programs.

What does this paper add?
Program coordinators commonly prioritise referrals and use participant entry criteria to select participants, with performance-based expectations an important consideration. Although higher demand and waiting list pressure appear to influence these performance-based considerations, programs do not report using the existing evidence identifying responders to pulmonary rehabilitation in selecting participants for program inclusion. This finding is a reflection of the inadequate evidence identifying which individuals are more likely to benefit from pulmonary rehabilitation.

What are the implications for practitioners?
With the current healthcare resources in Australia, pulmonary rehabilitation programs cannot meet the burden of all people with chronic obstructive pulmonary disease. Therefore the selection of participants considered most likely to benefit from pulmonary rehabilitation programs will continue to occur. Better criteria are needed to improve participant selection to ensure timely access to individuals that are most likely to benefit from pulmonary rehabilitation.