title: Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective.
abstract: OBJECTIVE
  To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation.
  
  
  METHODS
  Qualitative study using semi-structured interviews.
  
  
  METHODS
  Interviews conducted at participants' homes.
  
  
  METHODS
  Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic.
  
  
  METHODS
  Patients' beliefs about pulmonary rehabilitation, self-set treatment goals and anticipated reasons for drop-out.
  
  
  RESULTS
  Patients' beliefs about pulmonary rehabilitation comprised positive aspects (participation as an opportunity for improvement, a safe and multidisciplinary setting, presence of motivating and supporting patients) and negative aspects of exercising in a rehabilitation centre (e.g. disruption of normal routine, being tired after training, transportation difficulties, limited privacy and confrontation with severely ill patients). Four types of treatment goals were formulated: increase in functional performance, weight regulation, reduction of dyspnoea, and improvement of psychosocial well being. Four clusters of anticipated reasons for drop-out were identified: the intensity of the programme, barriers to attending (e.g. transportation problems, sudden illness and other duties/responsibilities), lack of improvement and social factors. Four different attitudes towards pulmonary rehabilitation could be distinguished: optimistic, 'wait and see', sceptic and pessimistic. Follow-up data revealed that whereas a pessimistic attitude (high disability, low self-confidence, many concerns) was related to decline, the 'sceptic' patients had dropped out during the course.
  
  
  CONCLUSIONS
  Uptake and drop-out may be related to patients' perceived disabilities, expected benefits and concerns with regard to rehabilitation, practical barriers and confidence in their own capabilities.
authors.affiliation: Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands. mfischer@fsw.leidenuniv.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Scharloo
authors.forename: J J
authors.initials: JJ
authors.lastname: Abbink
authors.forename: A
authors.initials: A
authors.lastname: Thijs-Van
authors.forename: A
authors.initials: A
authors.lastname: Rudolphus
authors.forename: L
authors.initials: L
authors.lastname: Snoei
authors.forename: J A
authors.initials: JA
authors.lastname: Weinman
authors.forename: A A
authors.initials: AA
authors.lastname: Kaptein
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010352:Patient Dropouts; D010358:Patient Participation; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*