Adherence to pulmonary rehabilitation: A qualitative study.

OBJECTIVES: To explore the experiences of chronic obstructive pulmonary disease (COPD) patients invited to join a pulmonary rehabilitation (PR) programme. PR has been shown to be an effective non-pharmacological intervention; however uptake and completion of programmes is frequently low.
DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Twenty COPD patients aged 45-85 years, referred for PR over a 2-year period.
RESULTS: In this group of patients the influence of the referring doctor was the key factor in leading patients to take up an invitation to attend a PR programme. Patients responded positively to doctors who imparted enthusiasm for, and belief in, the benefits of the intervention. Once started, ongoing adherence to the programme was positively influenced by a sense of group support, and increased self-confidence. Lack of social support at home and overcoming the effort of living with COPD in order to attend were cited as negative influences on continued adherence.
CONCLUSIONS: This study has shown that the referring doctor plays a key role in the uptake of PR programmes. It suggests that a positive approach by doctors could increase the level of adherence to PR. Recognition and support in the area of social support for those living alone may also increase adherence. These simple, cost effective approaches may encourage more patients with COPD to participate in a therapeutic intervention which now has a strong evidence base.