Pieces of the pulmonary rehabilitation puzzle: Referral, acceptance and uptake to pulmonary rehabilitation for chronic obstructive pulmonary disease
Bibliographic record
Abstract
Chronic obstructive pulmonary disease (COPD) is a life-limiting, progressive lung disease characterized by airflow limitation.In 2016, chronic respiratory diseases were the third highest cause of non-communicable disease mortality, with COPD leading to the most respiratory disease deaths.Individuals with COPD experience symptoms such as a chronic chesty cough, wheezing, breathlessness, phlegm, reduced exercise capacity, limb muscle dysfunction and psychological side-effects such as anxiety or depression.All of these symptoms lead to an impaired quality of life.Pulmonary rehabilitation (PR) is regarded as the cornerstone of non-pharmacological treatment for COPD, and is a comprehensive program centred on exercise intervention, but also consists of education and social and psychological support.However, there are many barriers in the PR pathway that can negatively affect access, referrals, acceptance, uptake, completion and adherence to PR.Within the context of this complicated PR situation, the objectives of this thesis were to: 1) answer specific research questions relating to referral, acceptance and uptake to PR in order to improve understanding of the respective barriers for healthcare professionals (HCPs) and patients with stable and unstable COPD; 2) provide recommendations for improving rates of referral to PR and; 3) provide recommendations for the future development of interventions to improve acceptance and uptake to PR post acute-exacerbation of COPD (AECOPD).This thesis consists of two studies presented as separate manuscripts.The first manuscript consists of a systematic scoping review identifying the rate of referral of patients with COPD to PR by HCPs, and the barriers and enablers to referral perceived by HCPs.Referral rates were found to range from 0%-85%, and the most common barriers to PR referral were low knowledge of what PR is, its benefits and the referral process.The second manuscript is a study assessing the acceptability, feasibility, and safety of delivering a PR taster session to patients hospitalized with an AECOPD.It also evaluates the changes in patient knowledge of, and readiness to commence PR.The PR taster i There are countless people I would like to thank for their assistance and love during this journey.If I have not named your personally, please forgive me -there are just too many wonderful supporters in my life to fit into a concise acknowledgment!Firstly, thank you to Dr. Tania Janaudis-Ferreira for all of your feedback and thoughtful discussions over the course of these two projects.The quality of my work would not be to such a high standard without such considered advice.
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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 | 0.068 | 0.269 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.009 | 0.012 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.005 | 0.006 |
| 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".