Short-Term Health Outcomes of a Structured Pulmonary Rehabilitation Program Implemented Within Rural Canadian Sites Compared With an Established Urban Site: A Pre-Post Intervention Observational Study

OBJECTIVES

To evaluate congruence in program delivery and short-term health outcomes of a structured pulmonary rehabilitation (S-PR) program implemented at 11 Canadian rural pulmonary rehabilitation (PR) sites compared with an urban reference site.

DESIGN

Multi-center, pre- and post-intervention, comparative, observational study.

SETTING

Eleven rural Canadian PR sites and 1 urban reference PR site.

PARTICIPANTS

Adults with chronic respiratory diseases (CRDs) referred to PR.

INTERVENTION

Clinicians at the reference site worked with local clinicians to implement the S-PR program in rural sites. A PR survey evaluated site congruence with the S-PR components, with congruence defined as delivering program components ≥80% in alignment with the S-PR program. Participants were enrolled in 16 sessions of group education and supervised exercise, offered twice or thrice a week. Health outcomes were tracked using a quality assurance database.

OUTCOME MEASURES

Main outcomes were congruence in program delivery and changes in the 6-minute walk (6MW) distance and COPD Assessment Test (CAT).

RESULTS

A total of 555 participants (rural n=204 and reference n=351) were included in the analyses. There was congruence in exercise and group education; however, individual education varied. Following the S-PR program, 6MW distance increased, with greater changes observed at rural sites (51±67 m at rural sites vs 30±46 m at the reference site). CAT score was reduced by -2.6±5.4 points with no difference between reference and rural sites. Changes in 6MW distance and CAT scores were similar for participants at sites that were congruent vs noncongruent with the individual education component, and similar for patients with COPD, asthma, bronchiectasis, and interstitial lung disease.

CONCLUSION

The S-PR program components can be implemented with good congruence in Canadian rural settings, resulting in similar short-term health outcomes as in an established urban site and across CRDs.

Exploring the Causes of Neck Pain and Disability as Perceived by Those Who Experience the Condition: A Mixed-Methods Study

Designing effective treatment protocols for neck-related disability has proven difficult. Disability has been examined from structural, emotional, and cognitive perspectives, with evidence supporting a multidimensional nature. The patient’s perspective of their condition has found increasing value for patient-centred, evidence-informed care. This cross-sectional study utilized descriptive thematic analysis to examine perceptions of causation in 118 people with neck pain. The Brief Illness Perceptions Questionnaire was used to capture perceptions of causation for neck pain symptoms. The Neck Disability Index, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, and the P4 pain intensity numeric rating scale were also collected. Eight main themes were found for the cause(s) of neck pain: posture and movement, structure and mechanism, emotions, predisposition and lifestyle, symptoms, fatigue and insomnia, treatment, and environment. A series of regression models stratified by perceived cause suggested that disability could be explained by different constructs across the larger of the main themes. The findings are discussed in terms of the false view that mechanical neck pain should be considered a homogenous condition and potential application to treatment decision making based on patient perspectives.