The Impact of Patient Preference on Attendance and Completion Rates at Centre-Based and mHealth Pulmonary Rehabilitation: A Non-Inferiority Pragmatic Clinical Trial

Abstract

Purpose

Pulmonary rehabilitation (PR) is vital in the management of chronic respiratory disorders (CRDs) although uptake, attendance and completion are poor. Differing models of delivering PR are emerging in an attempt to increase the uptake and completion of this intervention. This study aimed to evaluate participant rate of attendance and completion of PR when given a preference regarding model of delivery (centre-based and mPR). Secondary aims were to evaluate the factors affecting patient preference for model of delivery and determine whether mPR is non-inferior to centre-based PR in health outcomes.

Methods

A multi-centre non-inferiority preference based clinical trial in Auckland, New Zealand. Participants with a CRD referred for PR were offered the choice of centre-based or mHealth PR (mPR). The primary outcome was completion rate of chosen intervention.

Results

A total of 105 participants were recruited to the study with 67 (64%) preferring centre-based and 38 (36%) mPR. The odds of completing the PR programme were higher in the centre-based group compared to mPR (odds ratio 1.90 95% CI [0.83–4.35]). Participants opting for mPR were significantly younger (p = 0.002) and significantly more likely to be working (p = 0.0001). Results showed that mPR was not inferior to centre-based regarding changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ). When services were forced to transition to telehealth services during COVID-19 restrictions, the attendance and completion rates were higher with telephone calls and video conferencing compared to mPR – suggesting that synchronous interpersonal interactions with clinicians may facilitate the best attendance and completion rates.

Conclusion

When offered the choice of PR delivery method, the majority of participants preferred centre-based PR and this facilitated the best completion rates. mPR was the preferred choice for younger, working participants suggesting that mPR may offer a viable alternative to centre-based PR for some participants, especially younger, employed participants.

Keywords:

• chronic respiratory disorder
• mHealth
• preference
• pulmonary rehabilitation
• telehealth
• telerehabilitation

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Human/Animal Ethics Approval Declaration

This trial was approved by the New Zealand Health and Disability Ethics Committee (HDEC) (21/NTB/54). The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000365864p). All patients provided written informed consent.

Acknowledgments

The authors wish to acknowledge all the participants who participated in this study. We also would like to acknowledge the PR and support staff at Te Whatu Ora Counties Manukau and Waitemata, and the staff at NIHI. This work was funded by the MedTech CoRE (Medical Technologies Centre of Research Excellence), a collaboration of Universities and Callaghan Innovation in New Zealand (cmdt.org.nz), and the Royal Arch Masons, NZ.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was funded by the MedTech CoRE (Medical Technologies Centre of Research Excellence), a collaboration of Universities and Callaghan Innovation in New Zealand (cmdt.org.nz), and from the Royal Arch Masons, NZ.