Predictors of poor attendance at an outpatient pulmonary rehabilitation programme

Respir Med. 2008 Jun;102(6):819-24. doi: 10.1016/j.rmed.2008.01.019. Epub 2008 Mar 11.


Background: Pulmonary rehabilitation (PR) is recommended for patients with respiratory disease who feel limited by breathlessness. Poor attendance wastes finite resources, increases waiting times and is probably associated with poorer clinical outcomes. We investigated what factors, identifiable from routine hospital data, predict poor attendance once enrolled in a pulmonary rehabilitation programme (PRP).

Methods: Retrospective case note study of 239 patients (60% male) of mean (S.D.) age of 66.6 (8.7) years, mean FEV(1) 39.6 (14.6)% predicted, who attended a 6 (short) or 18 (long) week, 18 session, outpatient PRP. Attendance data was analysed using linear multiple regression analysis with the log transformed odds ratio of attendance as the dependant variable.

Results: Overall median attendance was 16 out of 18 sessions. Being a current smoker (p<0.05), attending a long PRP (p<0.05), more previous hospital admissions (p<0.01), higher Medical Research Council (MRC) dyspnoea score (p<0.01) or enduring a long journey (p<0.001) were independent risk factors for low attendance. Lower body mass index (BMI) and distance from PR centre were of borderline importance (p<0.1) but age, gender, co-morbidity, respiratory diagnosis, FEV(1) and St. Georges Respiratory Questionnaire Score at baseline did not predict later attendance (p>0.2).

Conclusions: Attendance at PRPs is independently influenced by smoking status, the degree of breathlessness, frequency of hospital admissions, length of the programme and journey time.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Asthma / physiopathology
  • Asthma / rehabilitation*
  • Body Mass Index
  • Female
  • Forced Expiratory Volume
  • Health Services Accessibility / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital / statistics & numerical data*
  • Patient Acceptance of Health Care*
  • Patient Compliance
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Retrospective Studies
  • Smoking / psychology
  • Time Factors
  • Wales