Adherence to pulmonary rehabilitation during a 12-month period in Dutch and Flemish patients with prolonged COPD treatment; a prospective cohort study

Background: Chronic diseases lead to both financial and organisational burdens on the health system. One of the possible solutions to keep health care affordable is self-management. However, non-adherence is a recognised problem with regard to self-management, especially in long-term treatment. Once it is clear who is or is not adherent, care can potentially be tailored accordingly. To predict adherence over time, it may be useful to have an understanding of how this variable might change over time: It is unclear whether adherence is a constant, or rather increases or decreases or fluctuates. The aim of this study is to determine the course of exercise adherence over a 12-month period in patients with chronic obstructive pulmonary disease (COPD) receiving prolonged rehabilitation. Methods: In this prospective cohort study participated 196 patients with COPD, who were undertaking pulmonary rehabilitation (PR), for at least one month, in 53 primary physiotherapy practices in The Netherlands and Belgium between January 2021 and August 2022. Outcomes were measured at baseline, and at 3, 6 and 12 months. The primary outcome was exercise adherence, and secondary outcomes were exercise capacity and health related quality of life. Multilevel regression analysis with adherence at the first level and patients at the second level were used for analyses of the data. Results: There was no significant change in exercise adherence over time (p = 0.89). Also, exercise capacity (p = 0.59) and health related quality of life (p= 0.24) remained stable. Conclusions: Adherence is constant over a period of 12 months in patients with COPD receiving prolonged pulmonary rehabilitation in a primary physiotherapy practice in The Netherlands and Belgium. Also, measured health outcomes remained constant in this same period. Possibly, this will allow for better tailored care over 12 months and lower health care costs.