A Qualitative Study to Inform a More Acceptable Pulmonary Rehabilitation Program after Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Bibliographic record
Abstract
Abstract Rationale Current international guidelines for prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) recommend enrolment and participation in a pulmonary rehabilitation (PR) program within 4 weeks of hospital discharge. However, there is poor uptake of these programs as well as low adherence and completion rates. Objectives The objectives of this study were to explore the views of patients and healthcare professionals (HCPs) on PR after AECOPD and how participation could be enhanced. Methods A qualitative study was undertaken, and data were analyzed using deductive thematic analysis. A total of 13 patients who had experienced an AECOPD in the previous 6 months and 11 HCPs experienced in the management of COPD participated in face-to-face, semistructured interviews. Patients and HCPs were recruited from both rehabilitation and acute hospital settings. Results Four main themes were identified: 1) uncertainty about timing of PR—most HCPs endorsed the professional guidelines that advocate for PR programs to begin within 4 weeks of an AECOPD; patients, however, varied drastically in their view of the ideal timing to start a PR program, anywhere from before an exacerbation (perhaps preventing one) and up to 6–8 weeks after exacerbation; 2) tailored and flexible manner to deliver PR programs with a gradual start—patients and HCPs talked about individually tailored programs with a gradual introduction of exercise and teaching sessions; some HCPs advocated allowing patients to pick and choose which elements would help them the most; 3) education for all—patients would like HCPs to be more informed and informative about the PR programs available in their neighborhoods, and HCPs focused on how they could educate patients about their disease and how better to manage it; and 4) logistical, disease-related, and psychological barriers—barriers to PR were discussed by both HCPs and patients; these fell into two categories: a) delivery issues (i.e., transportation and location of PR); and b) patient-specific issues (too sick or too well, high levels of anxiety). Conclusions Our findings lay the foundation for the development of a flexible, stepped-care approach to delivering PR after AECOPD, which should be tailored according to the needs and preferences of the individual.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.012 | 0.010 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".