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Extract Pulmonary rehabilitation is a cornerstone of chronic respiratory disease (CRD) management. Recommended by all international guidelines, it reliably improves physical endurance, decreases breathlessness and enhances health-related quality of life (HRQoL) 1–4. Nevertheless, one of the most persistent paradoxes remains unresolved: despite receiving an intervention of proven efficacy, a substantial proportion of patients – often between a third and half – fail to achieve clinically meaningful benefit 5–7. This phenomenon, termed “nonresponse”, has been documented repeatedly across a range of functional outcomes, patient-reported measures and even peripheral muscle strength 8, 9. Qualitative research has further demonstrated that nonresponse is not a neutral outcome: patients who do not improve report symptoms of distress, hopelessness and disengagement from their rehabilitation journey 10.
Eleonora Volpato (Fri,) studied this question.