Seasonal variation and living alone are related to pulmonary rehabilitation non-completion

AIM: To identify baseline characteristics that independently predict pulmonary rehabilitation non-completion and compare these findings against the participant's reasons for non-completion. METHODS: Participants with chronic obstructive pulmonary disease(COPD) who attended a standardised twice weekly, eight week pulmonary rehabilitation program(located in the sub-tropics, latitude 27°29' South) between 2010 and 2012 were recruited. Thebaseline characteristics of program completers and non-completers were compared in a case-controlled design. Participants who attended < 12/16 sessions were classified as a non-completer. Non-completers(those who missed > 4 session of the program) were asked by one independent investigator to participate in a survey about their pulmonary rehabilitation experience. Baseline characteristics were assessed for differences between program completers and non-completers. The baseline characteristics included disease severity, exercise capacity, smoking history, participant's social support and the season when each participant commenced rehabilitation. Non-completers that agreed to participate in the survey were asked to indicate what personal factors or external factors contributed to their program non-completion. Comparisons of completers and non-completers baseline characteristics were performed using cross-tabulations and t-tests, with significant measures analysed in a multivariate binary logistic regression model. Non-completers survey responses were compared to the identified independent predictors using cross-tabulations.RESULTS: Twenty-six participants(23.4%) of the 111 participants with COPD [(mean ± SD) age was 67.4 ± 9.2 years and FEV1 54.6% ± 22.3%)], were classified as non-completers. Forty-five participants(40.5%) commenced pulmonary rehabilitation during winter. Thirty-six participants(32.4%) were living alone at program commencement. In the multivariate analysis(n = 111), only programs that commenced in winter(Exp B: 0.255, 95%CI: 0.090-0.727, P = 0.011) and participants that lived alone(Exp B: 2.925, 95%CI: 1.039-8.229, P = 0.042) were identified as independent predictors of program non-completion. Twenty participants of the twenty-six non-completers agreed to participate in the survey about their pulmonary rehabilitation experience. The reasons given for non-completion were grouped into: medical reasons(75%), other personal reasons(30%) and external barriers(45%), with ten non-completers reporting more than one reason.No participant reported living alone or that the program commenced during winter as a reason for noncompletion. There was no relationship between illness being the participant's reason for non-completion and the programs that commenced in winter(P = 0.135). CONCLUSION: Despite winter commencing programs and participants who lived alone being independent predictors of program non-completion, neither measure was reported by participants as a reason for noncompletion.