Out-of-hours pulmonary rehabilitation classes for workers with COPD: a qualitative evaluation.

Problem

Chronic obstructive pulmonary disease (COPD) is a common, progressive condition. Work productivity, attendance and quality of life have been associated with clinical outcomes of COPD. Rates of employment fall with rising disease severity.Pulmonary rehabilitation (PR) is a NICE recommended intervention for COPD. There is strong evidence for its effectiveness in improving common symptoms of COPD: breathlessness, fatigue, cough, and in improving exercise capacity and disease mastery.The impact of PR is restricted by poor rates of completion (typically around 40%) with numerous barriers to attendance documented. Referrals by GPs lead to lower rates of completion than by other professional groups. PR classes are offered during the working day. Attendance is challenging for workers. The UK has one of the highest proportions (52%) of people prevented from working due to their COPD an outcome that might be improved by early PR referral.

Approach

The aim of this project was to explore COPD-related job retention through a targeted out-of-hours PR programme. The views of working patients referred for the programme and of staff members running it were sought in focus groups. Those unable to attend were offered telephone interviews. Focus groups and interviews were recorded and transcribed verbatim. Thematic analysis was completed.

Findings

Seven patients and seven staff members participated. Four participants attended the patient focus group, three patient gave telephone interviews. Five staff members attended the focus group for staff, two gave telephone interviews. For patient participants COPD-related symptoms had a significant impact on work capacity, especially for manual workers. One had changed from manual to less physically demanding work, others had made adjustments but remained with the same employer. Workers with COPD had great difficulty attending PR during the working week. Workers with COPD clearly found PR beneficial:‘It helped me sort of focus and centre and just improve my overall fitness levels. Particularly with learning how to breath properly as well as doing the exercises seemed to help enormously ‘ (workers focus group).Staff had to find a suitable venue and adjust weekend staffing to ensure the course could run. Staff reported failing to pick up work-related COPD issues if people were managing to attend work:‘‘I think there is an assumption that if you’re holding down a job that you’re fine’ (staff focus group)

Consequences

Access to PR for workers with COPD is severely limited where services are only provided in the working week. Working COPD patients may have less contact with medical care and be especially dependent on their GPs to refer them for PR. Findings indicate the improvement in functional capacity achieved by PR has the potential to reduce the risk of early job loss. A future trial of more accessible, worker-friendly, PR is planned to test this.