Why do hospitalised COPD patients decline pulmonary rehabilitation? (ID 443)

Clinch L, Gardiner N, Hawksley Z, Houchen-Wolloff L

Leicester Hospitals

Funding: none

Abstract

Introduction
Medical advancements in managing chronic obstructive pulmonary disease (COPD) and other long-term conditions can mean that patients are living longer with a high burden of symptoms and frailty. Despite worldwide consensus that pulmonary rehabilitation (PR) improves outcomes for patients after an COPD exacerbation, less than 15% of patients are referred.
Aims
• To understand the reasons why patients decline a referral to PR
• To analyse the profile of patients to understand potential barriers to a traditional model of PR
Method
The nursing record of 637 patients admitted to hospital with an exacerbation of COPD between September 2022 and March 2023 were reviewed. The record included a frailty score(1).
Results
Common co-morbidities included cardiac and vascular conditions, anxiety and depression and muscular-skeletal conditions (Figure 1). However, 98 patients (15%) had no existing co-morbidity.
PR referrals were made for 195 (31%) patients; 173 (27%) were deemed too frail; 2 (0.3%) were too active and 267 (42%) declined, citing
(i) completed PR in the past and know what to do (38%)
(ii) not wanting to do it (34%)
(iii) previously completed PR but no longer felt able (16%)
(iv) work schedule (4%)
(v) transport issues (6%) despite an offer of virtual alternatives
(vi) Carer responsibility (1%)
(vii) Reason not recorded (1%)
A group of 484 (76%) patients were assessed by a COPD Specialist Nurses as having some degree of frailty (Figure 2). Despite this 139 (29%) agreed to a PR referral. Clinicians judged that some patients were ‘inappropriate’ for a traditional PR programme due to their frailty during the hospital admission.
Conclusion
Patients resist the offer of PR despite the benefits being explained and further exploration of individuals motivation is required.
Alternative approaches to post-exacerbation PR that addresses issues of frailty may increase the numbers of patients who agree to PR.

Conflicts of interest: none

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