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Study Highlights Gaps in Awareness of COPD Pulmonary Rehabilitation


A small study conducted in Melbourne, Australia, found that older age and being from a culturally and linguistically diverse community were associated with less awareness of pulmonary rehabilitation among patients with chronic obstructive pulmonary disease (COPD).

Patients with chronic obstructive pulmonary disease (COPD) were less likely to be aware of pulmonary rehabilitation (PR) if they were older or from a culturally or linguistically diverse community (CALD), according to a study published in Health and Social Care in the Community. This result highlights the need to boost engagement in PR among patients with COPD.

The primary aim of the study was to understand the extent of cultural and linguistic diversity among people with COPD in the multicultural region of Melbourne, Australia. The secondary aim was to identify the variables that influenced the level of awareness, referral, attendance, and completion of PR.

Participants were recruited through 2 hospital-based respiratory outpatient clinics located in Melbourne. Patients who attended the respiratory outpatient clinics with a confirmed diagnosis of COPD were eligible to participate, including patients attending the clinic for initial consultation. An inability to provide written informed consent due to cognitive impairment was the only exclusion criteria.

Everyone completed a paper-based study-specific questionnaire at consultation that contained 22 questions about such variables as age, country of birth, self-perceived proficiency in English, and intent to participate in future PR programs. Participants who were not native English speakers were offered interpreters. Data were collected from August 2017 to August 2018 for 100 participants, and engagement in PR was recorded using 3 categories: referral, attendance, and completion. Their mean (SD) age was 68 (9) years.

Participants were classified as being from a CALD background if they reported being born or had 1 or both of their parents born in countries where English was not the main speaking language, spoke multiple languages other than English, and/or self-identified as being from a different cultural group other than Anglo-Australian culture.

A multiple regression analysis was conducted to investigate the relationship between independent variables such as age, sex, CALD, MRC dyspnea score, level of education, and proficiency of English and response variables that included awareness of PR and referrals.

Among the 97 completed questionnaires, 36 participants noted they came from a CALD background. Most (91%) were born overseas, and Maltese, Vietnamese, Italian, and Greek were the 4 most common languages spoken at home besides English. For the 61 participants who were part of the non-CALD group, 3 identified as having Aboriginal and Torres Strait Islander ancestry.

Participants in the CALD group were 2.6 times less likely to have heard about PR compared with the participants in the non-CALD group. However, both groups had similar rates of attendance and completion of previous PR and willingness to participate in future PR programs. There were also no between-group differences in referrals, attendance, and completion of PR following respiratory consultation.

Of the 45% of participants who were referred to PR, approximately half attended PR and half went on to complete the program. In total, 11 of the 97 participants (11%) completed PR.

A multivariable regression analysis revealed that older age and CALD background were independent factors associated with awareness of PR, and English proficiency was associated with referrals to PR.

There were some limitations to this study. It is likely that the absence of nonsignificant between-group differences was due to the presence of a Hawthorne effect among the respiratory team who knew about the purpose of the study. The study also was conducted within a single health service with a small sample size, which influences the generalizability of the data.

The researchers concluded that the study suggests that 4 in 10 people with COPD who attended the respiratory clinic were from a CALD group, with older people from CALD backgrounds being the least likely to be aware of PR.

“While the referrals to attendance and completion of PR were similar between groups, the overall poor engagement in PR highlights the importance of urgent strategies to improve engagement. Attendance to the respiratory clinic also appeared to be critical for the referral to PR emphasizing the importance of clinicians initiating referrals to PR,” the authors wrote.


Tang CY, Lavercombe M, Southcott AM, Taylor NF, Blackstock FC. Access to pulmonary rehabilitation for people from culturally and linguistically diverse communities: a cohort study. Health Soc Care Community. Published online March 29, 2022. doi:10.1111/hsc.13807

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