title: Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence.
abstract: BACKGROUND
  Pulmonary rehabilitation (PR) is efficacious in chronic obstructive pulmonary disease (COPD). As completion rates of PR are poor, we wished to assess predictors of attendance and adherence.
  
  
  METHODS
  We performed a retrospective analysis of 711 patients with COPD, who were invited to attend PR. Data were compared to allow predictors (gender, smoking status, attending partner, referral route, employment status, body mass index, forced expiratory volume in 1 s (FEV(1)), oxygen therapy (LTOT), oxygen saturations, chronic respiratory questionnaire (CRQ), shuttle walk distance, travel distance and time) of attendance (0 or >0 attendance) and adherence (< or >63% attendance) to be identified.
  
  
  RESULTS
  31.8% of patients referred for PR did not attend and a further 29.1% were non-adherent. Predictors of non-attendance were female gender, current smoker, and living alone. Predictors of non-adherence were extremes of age, current smoking, LTOT use, FEV(1), CRQ score and travelling distance. Multiple logistic regression revealed that LTOT and living alone were independent predictors of poor attendance and current smoking, poor shuttle walking distance and hospitalisations were independent predictors of poor adherence.
  
  
  CONCLUSIONS
  Smoking status, availability of social support and markers of disease severity were predictors of attendance and adherence to PR.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
authors.forename: Conal
authors.initials: C
authors.lastname: Hayton
authors.forename: Allan
authors.initials: A
authors.lastname: Clark
authors.forename: Sandra
authors.initials: S
authors.lastname: Olive
authors.forename: Paula
authors.initials: P
authors.lastname: Browne
authors.forename: Penny
authors.initials: P
authors.lastname: Galey
authors.forename: Emma
authors.initials: E
authors.lastname: Knights
authors.forename: Lindi
authors.initials: L
authors.lastname: Staunton
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.forename: Emma
authors.initials: E
authors.lastname: Coombes
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wilson
mesh_terms: D000367:Age Factors; D000368:Aged; D004739:England; D005081:Exercise Therapy / Q000379:methods / Q000523:psychology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000523:psychology; D012944:Social Support