VA New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
VA Boston Healthcare System, Boston, MA.
Arch Phys Med Rehabil. 2022 Jun;103(6):1113-1121.e1. doi: 10.1016/j.apmr.2021.10.021. Epub 2021 Nov 29.
To examine predictors of uptake (never start), adherence (drop out), and completion of pulmonary rehabilitation (PR), as well as PR treatment response based on minimal clinically important difference (MCID) on the 6-minute walk test (6MWT) distance and Chronic Respiratory Questionnaire-Self-Report (CRQ-SR).
Retrospective, cohort study.
Veterans Health Administration.
U.S. veterans with chronic obstructive pulmonary disease (COPD) (N=253) referred to PR between 2010 and 2018.
Outpatient PR program.
Participants completed baseline (time 1) measures of depression (Beck Depression Inventory-II), health-related quality of life (CRQ-SR), self-efficacy (Exercise Self-Regulatory Efficacy Scale [Ex-SRES]), and COPD knowledge. Exercise capacity was assessed with the 6MWT. Participants who completed all 18 sessions of PR repeated assessments (time 2). Logistic regression models examined predictors of uptake, adherence, and completion of PR as well as treatment response based on MCID.
Participants were referred to PR with 24.90% never starting, 28.90% dropping out, and 46.20% completing. No differences emerged between never starters and dropouts. Having a history of any cancer increased the likelihood of completing PR (vs never starting; odds ratio [OR], 3.18; P=.003). Greater CRQ-SR dyspnea score, indicating less dyspnea, was associated with increased likelihood of completing PR (OR, 1.12; P=.006). Past smoking compared with current smoking was associated with increased likelihood of completion (OR, 3.89; P≤.002). Those without a history of alcohol use disorder had increased likelihood of completing PR (OR, 2.23; P=.048). Greater baseline 6MWT distance was associated with lower likelihood of achieving MCID in 6MWT (OR, 0.99; P<.001). Greater Ex-SRES was associated with decreased likelihood of achieving 6MWT MCID (OR, 0.98; P=.023).
Findings suggest that early psychoeducation on dyspnea management and smoking and alcohol cessation may increase completion of PR.
考察基于 6 分钟步行试验（6MWT）距离和慢性呼吸系统问卷-自我报告（CRQ-SR）的最小临床重要差异（MCID），评估接受（从不开始）、依从性（脱落）和完成肺康复（PR）的预测因素，以及 PR 治疗反应。
回顾性队列研究。
退伍军人健康管理局。
2010 年至 2018 年间被转诊至 PR 的美国慢性阻塞性肺疾病（COPD）退伍军人（N=253）。
门诊 PR 计划。
参与者完成基线（时间 1）时的抑郁（贝克抑郁量表-II）、健康相关生活质量（CRQ-SR）、自我效能（运动自我调节效能量表 [Ex-SRES]）和 COPD 知识的评估。运动能力通过 6MWT 进行评估。完成 PR 全部 18 次疗程的参与者重复评估（时间 2）。逻辑回归模型考察了接受、依从和完成 PR 以及基于 MCID 的治疗反应的预测因素。
参与者被转诊至 PR 的比例分别为：从不开始 24.90%、脱落 28.90%和完成 46.20%。从不开始者和脱落者之间没有差异。有任何癌症病史的患者完成 PR 的可能性增加（与从不开始相比；比值比 [OR]，3.18；P=.003）。CRQ-SR 呼吸困难评分较高，表明呼吸困难程度较低，与完成 PR 的可能性增加相关（OR，1.12；P=.006）。与当前吸烟相比，既往吸烟与完成可能性增加相关（OR，3.89；P≤.002）。没有酒精使用障碍病史的患者完成 PR 的可能性增加（OR，2.23；P=.048）。基线 6MWT 距离越大，6MWT 达到 MCID 的可能性越低（OR，0.99；P<.001）。Ex-SRES 越大，达到 6MWT MCID 的可能性越低（OR，0.98；P=.023）。
研究结果表明，早期进行呼吸困难管理和戒烟戒酒的心理教育可能会增加 PR 的完成率。
