Is attendance and completion of a pulmonary rehabilitation programme associated with patient activation

Introduction: Patient activation (PA), an individual9s knowledge, skill and confidence in managing their health, can be measured using the PAM, a 13-item measure. Low engagement in self-management has been reported in those with COPD (Korpershoek, Y et al Int J COPD 2016;11:1757-1766). Pulmonary rehabilitation (PR) is a high-value intervention for COPD and is recommended for other lung diseases, PA may affect willingness to participate in PR. Aim: To assess whether an association exists between the PAM and patient attendance and completion of PR; to identify whether PA changes following completion of PR. Method: Patients assessed as appropriate for PR from November 2016 to December 2017 completed the PAM at assessment. Those who completed PR within the time period repeated the PAM post-PR. Results: 140 patients were assessed (67% COPD) mean±SD age 66±9.6years, median MRC(IQR) score 3(3-4), 58 completed PR, 49 had pre- and post-PAM data. There was a significant increase in PAM score post-PR, mean difference (95% CI; p-value) 3.6(.2 to 7.0); 0.038), but no change in PAM levels. There was no difference in either mean±SD PAM scores (53.6±5.9; 58.7±14.9; 54.7±10.8; p=0.75) or median(IQR) PAM levels (2.5(1.8 to 3.0); 3.0(2.0 to 3.0); 2.5(1.8 to 3.0); p=0.366), between those who did not attend PR, those who attended but did not complete and those who completed PR, respectively. Conclusion: No association between PA and attendance or completion of PR was identified, however, PR may improve PA. The meaningfulness of the observed change in PAM score is unclear as PAM level did not improve. Further research should explore the PAM in relation to other factors known to influence PR attendance.