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Pulmonary Rehabilitation Scheduling and Engagement: A Multi-Site Virtual PR Cohort Analysis
ABSTRACT
Background:
Pulmonary rehabilitation (PR) is demonstrated to reduce both morbidity and mortality among chronic obstructive pulmonary disease (COPD) patients. Beyond survival, PR enhances exercise capacity, quality of life, and psychological outcomes. Despite its established efficacy, patient adherence remains poor, with completion rates for in-person programs frequently reported below 50%.
Objective:
Virtual PR has emerged as a potential alternative, yielding comparable clinical benefits with improved participation rates. However, determinants for adherence in virtual PR remain poorly defined. The aim of this study is to examine patterns of adherence and determine predictors of dropout in a virtual PR program.
Methods:
A total of 658 patients from five outpatient pulmonary clinics who were referred to an 18-week virtual PR program were included in this study. The enrollment step with the greatest decline in program participation was identified. After establishing this point, the relationship between the time interval from onboarding completion to first session scheduling and subsequent attendance at that session was evaluated using logistic regression. Data analysis was performed using Rstudio with p<0.05.
Results:
The largest post-enrollment decline in PR participation occurred between the completion of onboarding to scheduling of the first session, with adherence dropping from 61.3% to 55.6%. Longer intervals between onboarding completion and scheduling of the first session were significantly associated with lower attendance (odds ratio, 0.959; p<0.001). The probability of attending the first session decreased by an average of 4.1% for each additional day between onboarding and session scheduling. The steepest decline occurred between days 24-30 after onboarding completion, with an average decrease of 14.3%.
Conclusions:
Adherence to virtual PR declined most prominently between onboarding and the first scheduled session. Delays in scheduling were strongly associated with lower attendance, with the probability of participation decreasing substantially as the interval lengthened. These findings highlight the importance of minimizing the time before session scheduling. Streamlining enrollment and scheduling represents only one actionable way to target improved patient retention. Given the burden of COPD and its impact on morbidity, mortality, and quality of life, optimizing program design to maximize adherence is essential to improving clinical outcomes. Clinical Trial: N/a
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