Open AccessImpact of patient characteristics and perceived barriers on referral to exercise rehabilitation among patients with pulmonary hypertension in the United States
Author(s) -
Cascino Thomas M.,
Ashur Carmel,
Richardson Caroline R.,
Jackson Elizabeth A.,
McLaughlin Vallerie V.
Publication year - 2020
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045894020974926
Subject(s) - medicine , referral , socioeconomic status , odds ratio , pulmonary rehabilitation , odds , rehabilitation , physical therapy , cross sectional study , body mass index , psychological intervention , quality of life (healthcare) , confidence interval , family medicine , population , logistic regression , environmental health , nursing , pathology
Exercise rehabilitation is underutilized in patients with pulmonary arterial hypertension despite improving exercise capacity and quality of life. We sought to understand the association between (1) patient characteristics and (2) patient‐perceived barriers and referral to exercise rehabilitation. We performed a cross‐sectional survey of patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension attending an International PAH meeting. Predictors of referral considered included gender, body mass index, subjective socioeconomic status, insurance type, age, and World Health Organization functional class and perceived barriers assessed using the Cardiac Rehabilitation Barriers Scale. Among 65 participants, those in the lowest subjective socioeconomic status tertile had reduced odds of referral compared to the highest tertile participants (odds ratio 0.22, 95% confidence interval: 0.05–0.98, p = 0.047). Several patient‐perceived barriers were associated with reduced odds of referral. For every 1‐unit increase in a reported barrier on a five‐point Likert scale, odds of referral were reduced by 85% for my doctor did not feel it was necessary; 85% for prefer to take care of my health alone, not in a group; 78% many people with heart and lung problems don’t go, and they are fine; and 78% for I didn’t know about exercise therapy. The lack of perceived need subscale and overall barriers score were associated with a 92% and 77% reduced odds of referral, respectively. These data suggest the need to explore interventions to promote referral among low socioeconomic status patients and address perceived need for the therapy.