Experiences in responders and non-responders to pulmonary rehabilitation among people with chronic obstructive pulmonary disease: a clinical study with convergent mixed analysis

PURPOSE: This study aims to investigate the experienced and measured development in physical capacity in people with Chronic Obstructive Pulmonary Disease (COPD) undergoing a standard pulmonary rehabilitation programme with a focus on the diverging experiences of responders and non-responders.

METHODS: Twenty-one participants in standard pulmonary rehabilitation were included in the study. We measured the participants' change in the six-minute walk test (6MWT) during rehabilitation participation. We investigated their experiences of the changes in their physical capacity by combined participant observations and interviews. A convergent mixed analysis was conducted of the coherent data.

RESULTS: Standard pulmonary rehabilitation had a different physical impact on people with COPD. Responders were delighted by a positive physical change, which improved their daily functioning and capability of fulfilling personal priorities. However, non-responders experienced decreased capacity and a lack of trust in their future. All participants found it challenging to exercise and achieve sustainable exercise habits.

CONCLUSION: In this qualitative study, we found that absence of expected improvement to pulmonary rehabilitation seems to confer distress and feelings of hopelessness. The achievement of sustainable change in daily exercise behaviour appears yet to be insufficient. Thus, new and more individualized models of physiotherapists' guidance in exercise are imperative.Implications for rehabilitationIt is vital to acknowledge differential response to people with the chronic obstructive pulmonary disease following eight-week standard pulmonary rehabilitation.Especially noteworthy feelings of distress and hopelessness are prominent to non-responders because of the absence of the promised improvements.Both responders and non-responders require intensive physiotherapist guidance to exercise.It is recommended to ensure individualised support to people with chronic obstructive pulmonary disease in rehabilitation programmes.