Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Predictors of Program Completion and Success

Abstract

Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD), there are insufficient resources to provide PR to all patients with COPD. Thus, predicting which patients are at risk for drop-out and non-response to rehabilitation is necessary in order to optimize limited resources. This study examined which patient characteristics are predictive of PR drop-out and non-response. 814 patients with COPD took part in standard out-patient PR for 8 weeks. Demographic and standard clinical data were collected before the rehabilitation program had started. Data was analyzed retrospectively to determine if baseline patient characteristics could predict drop-out and non-response to rehabilitation. Drop-out was defined as participation in less than 50% of the rehabilitation sessions. Non-response was defined as improvement less than 4% on the St. George's Respiratory Questionnaire (SGRQ). A discriminant function analysis identified age, smoking history, and health status as predictors of patient drop-out, p < .0001, with younger, current smokers and patients with lower health status being at risk for drop-out. No variables measured significantly predicted who those at risk would be for non-response to rehabilitation, p > .05. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.     

The use of a Sense of Coherence Test to Predict Drop-Out and Mortality After Residential Treatment of Substance Abuse

Sixty patients in a random sample of all patients (n = 487) referred to six facilities for substance abusers (three rehabilitation and three psychiatrically oriented institutions) were interviewed in 1993 using a test of coping and social integration. One year after admission, the relationship between length of stay and coping (measured using Antonovsky's Sense of Coherence Test, SOC), social integration, sex and type of facility was determined. Social integration was measured on a ten-point scale in both normal and substance-abusing cultures. The drop-out rate for women was 43% less than for men. Drop-out rate for abusers with a normal SOC rating was 65% less than for abusers with a lower rating. Degree of social integration and type of facility did not differ significantly. Six years after entry, four men and three women had died (11.7%), all had a low rating on the SOC scale. Being a woman, rating normally on the SOC scale and having a high degree of social integration at entry were significant predictors of survival, both separately and taken together six years after entry, p<.01.     

Engagement in Alcohol Treatment: The Client's Experience of,and Satisfaction with,the Assessment Interview

Clients' experiences of routine alcohol assessment interviews at a therapeutic day unit were studied in order to enhance understanding of the factors associated with subsequent engagement in treatment. The paper describes the development and use of the Client's Experiences and Satisfaction Questionnaire. The main finding from its use with 131 clients, was a positive association between the client's perceptions of the quality of the therapeutic relationship established during the interview, and subsequent engagement in treatment. Large differences were found between the engagement rates of different workers. Clients who were being referred for the first time and those with a SADQ score below 30 were less likely to engage. The findings are augmented with quotes from the clients themselves.     

A Win-Win Peer Mentoring and Tutoring Program: A Collaborative Model

The Big Buddies' Program is a unique peer mentoring and tutoring project that was able to simultaneously address major service effectiveness issues at three local community organizations. Through a collaborative effort, these agencies designed this innovative approach for preventing school dropout, increasing youth's interest in volunteerism, and expanding real-world learning experiences for university undergraduate students in social work. The article outlines in detail the program set-up, selection of participants, schedule and location of buddy time, content of mentor/tutor training, coordination of the program, use of materials with plans, and the program evaluation design. Future implications of the model are provided along with guidelines for duplicating this innovative collaborative approach in other communities.     

A dietary and behavioural programme for the treatment of obesity. A 4-year clinical trial and a long-term posttreatment follow-up

OBJECTIVES: To evaluate weight loss maintenance after 4 years of nonpharmacological, nonsurgical obesity treatment, including a very low calorie diet (VLCD), diet and behavioural support. Furthermore, to assess weight development amongst completers and noncompleters beyond the active 4-year treatment period. DESIGN: Clinical trial. SETTING: Two Swedish county hospitals. SUBJECTS: A total of 113 patients were randomized to a 2-year treatment programme with or without an initial VLCD period. The 87 patients who completed the 2-year programme were offered the chance to continue a support programme for another 2 years. A total of 55 patients completed the entire 4-year programme. INTERVENTIONS: All the patients took part in a comprehensive support programme, including a hypocaloric diet and behavioural support, either as single treatment (non-VLCD group) or following the VLCD period (VLCD group). RESULTS: Significant 4-year weight losses were found in both groups, 7.6 +/- 12.2 kg (VLCD group) and 6.3 +/- 8.5 kg (non-VLCD group), (P < 0.01, n.s. between groups). The completers (n = 55) had maintained a weight loss of 3.3 +/- 10.7 kg (P < 0.05) 8 years after randomization. After 6 years, the noncompleters (n = 58) had gained 3.2 +/- 9.7 kg compared with baseline (P < 0.05). The difference in weight change between completers and non-completers was highly significant (P < 0.01). CONCLUSIONS: Highly significant weight losses can be maintained after a 4-year comprehensive treatment programme, including a hypocaloric diet and behavioural support. An initial VLCD period did not significantly affect the long-term weight loss. The posttreatment long-term weight loss was larger amongst completers than amongst patients who did not complete the treatment.     

美沙酮维持治疗者脱失的影响因素单中心调查分析

目的分析单中心美沙酮维持治疗者脱失的资料,探讨治疗脱失相关影响因素。方法样本来源于上海市虹口区精神卫生中心美沙酮维持治疗门诊的海洛因依赖者。研究组(n=54)为服药时间不足3个月退出治疗者,对照组(n=107)为服药时间超过6个月仍在维持治疗者。调查两组研究对象的社会人口学特征、成瘾程度、戒毒治疗、应对方式、社会支持等情况,分析各种潜在因素对海洛因依赖患者美沙酮维持治疗依从性的影响。结果对维持治疗的认识缺乏、低积极应对水平、高消极应对水平、社会支持差是影响美沙酮维持治疗脱失的危险因素。结论应针对危险因素实施综合干预,降低美沙酮维持患者的脱失率。     

Detailed investigation of factors influencing amplification efficiency and allele drop-out in single cell PCR: implications for preimplantation genetic diagnosis

Preimplantation genetic diagnosis (PGD) of single gene disorders relies on PCR-based tests performed on single cells (polar bodies or blastomeres). Despite the use of increasingly robust protocols, allele drop-out (ADO; the failure to amplify one of the two alleles in a heterozygous cell) remains a significant problem for diagnosis using single cell PCR. In extreme cases ADO can affect >40% of amplifications and has already caused several PGD misdiagnoses. We suggest that an improved understanding of the origins of ADO will allow development of more reliable PCR assays. In this study we carefully varied reaction conditions in >3000 single cell amplifications, allowing factors influencing ADO rates to be identified. ADO was found to be affected by amplicon size, amount of DNA degradation, freezing and thawing, the PCR programme, and the number of cells simultaneously amplified. Factors found to have little or no affect on ADO were local DNA sequence, denaturing temperature (94 or 96 degrees C) and cell type. Consideration of the causal factors identified during this study should permit the design of PGD protocols that experience little ADO, thus improving the accuracy of PGD for single gene disorders.     

Successful application of preimplantation genetic diagnosis for beta-thalassaemia and sickle cell anaemia in Italy

BACKGROUND: In Italy, the autosomal recessive diseases beta-thalassaemia and sickle cell anaemia are so widespread that in some regions they can be defined as 'social diseases'. In this study, nine clinical applications of preimplantation genetic diagnosis (PGD) were performed for beta-thalassaemia and sickle cell anaemia on seven Sicilian couples and carriers of beta-globin gene mutations. METHODS AND RESULTS: The studied mutations were: Cd39, HbS, IVS1 nt1, IVS1 nt6 and IVS1 nt110. ICSI was performed with partner's sperm on 131 out of 147 retrieved oocytes, and this resulted in 72 zygotes; 32 embryos were successfully biopsied on day 3. The biopsied blastomeres were lysed and the beta-globin alleles amplified by nested PCR. The mutation diagnosis was performed by restriction enzyme digestion and reverse dot-blot. The amplification efficacy was 97.2%. The genotype study of non-transferred and surplus embryos showed that the allele drop-out rate was 8.6%. Seventeen embryos were transferred in utero on day 4. All couples received an embryo transfer; of the four pregnancies obtained, three resulted in live births and one miscarried at 11 weeks. Prenatal diagnosis at the 11th week and miscarriage material analysis confirmed the PGD results. CONCLUSIONS: These studies represent the first successful application of PGD for beta-thalassaemia and sickle cell anaemia in Italy.     

Competence, perceived importance of competence and drop-out from soccer: a study of young players

The purpose of this study was to examine the psychological centrality hypothesis and the selectivity/discounting hypothesis advanced by Rosenberg and Harter and the motivational consequences thereof within the context of soccer. A representative sample of 223 young soccer players aged 12–16 who were interviewed twice within a period of 16 months served as subjects. Within the younger as well as the older group of players, the psychological centrality hypothesis received support in that the influence of perceived soccer competence upon soccer-related self-esteem was shown to be dependent upon the personal importance of one's own soccer competence. The psychological selectivity/discounting hypothesis, stating that players actively value or devalue how personally important they consider soccer competence to be as a result of changes in the perception of such competence, was also supported. Additional results showed that perceived importance of soccer competence did neither mediate nor moderate soccer drop-out among players with low perceived soccer competence. Low perceived soccer competence, on the other hand, clearly mediated the relationship between low actual soccer competence and increased drop-out within the group of older players.