Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective

Objective: To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation. Design: Qualitative study using semi-structured interviews. Setting: Interviews conducted at participants' homes. Subjects: Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic. Main measures: 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.