Abstract

ABSTRACT Pulmonary rehabilitation is considered a key management strategy for chronic obstructive
pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion.
The aim of this review was to identify, select and synthesise the available evidence on interventions for
improving uptake and completion of pulmonary rehabilitation in COPD.
Electronic databases and trial registers were searched for randomised trials evaluating the effect of an
intervention compared with a concurrent control group on patient uptake and completion. The primary
outcomes were the number of participants who attended a baseline assessment and at least one session of
pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment
(completion).
Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria
and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater
programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a
tablet computer (enabled with support for exercise training) compared with controls ( pulmonary
rehabilitation only).
There is insufficient evidence to guide clinical practice on interventions for improving patient uptake
and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to
pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in
this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in
undermining wider implementation of pulmonary rehabilitation and restricting patient access to a
treatment considered the cornerstone of COPD.