title: Patient Profile of Drop-Outs From a Pulmonary Rehabilitation Program.
abstract: BACKGROUND
  While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common.
  
  
  OBJECTIVE
  The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics.
  
  
  METHODS
  A prospective study was performed between February and November 2015in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session).
  
  
  RESULTS
  A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P=.03), worse results on submaximal exercise test (NA, 6.2minutes vs A, 9.2minutes; P=.02), in total distance walked (NA, 42.6 vs A, 56.5; P=.03) and VO2in ml/min/kg (NA, 11.4 vs A, 13.6; P=.03) and in ml/min (NA, 839 vs A, 1020; P=.04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P=.01).
  
  
  CONCLUSIONS
  More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit.
authors.affiliation: Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España. Electronic address: virginiacadiz@yahoo.es.
authors.forename: Virginia
authors.initials: V
authors.lastname: Almadana Pacheco
authors.affiliation: Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: María
authors.initials: M
authors.lastname: Pavón Masa
authors.affiliation: Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Ana Paulina
authors.initials: AP
authors.lastname: Gómez-Bastero Fernández
authors.affiliation: Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Ana Mirian
authors.initials: AM
authors.lastname: Muñiz Rodríguez
authors.affiliation: Servicio de Medicina Física y Rehabilitación, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Tallón Moreno
authors.affiliation: Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Teodoro
authors.initials: T
authors.lastname: Montemayor Rubio
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D055070:Resistance Training; D012907:Smoking; D014187:Transportation of Patients
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Adherence; Adherencia; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Pulmonary rehabilitation; Rehabilitación respiratoria