Does pulmonary rehabilitation work in clinical practice? A review on selection and dropout in randomized controlled trials on pulmonary rehabilitation
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AIM: To analyze randomized controlled trials (RCTs) on pulmonary rehabilitation (PR) to determine whether the patients who complete PR form a representative subset of the chronic obstructive pulmonary disease (COPD) target population and to discuss what impact this may have for the generalizability and implementation of PR in practice. MATERIAL AND METHODS: A review of 26 RCTs included in a Cochrane Review 2007. We analyzed the selection at three different levels: 1) sampling; 2) inclusion and exclusion; 3) and dropout. RESULTS: Of 26 studies only 3 (12%) described the sampling as the number of patients contacted. In these studies 28% completed PR. In all we found, that 75% of the patients suitable for PR programs were omitted due to sampling exclusion and dropout. Most of the study populations are not representative of the target population. CONCLUSION: The RCTs selected for the Cochrane review gave sparse information about the sampling procedure. The demand for high internal validity in studies on PR reduced their external validity. The patients completing PR programs in RCTs were not drawn from a representative subset of the target population. The ability to draw conclusions relevant to clinical practice from the results of the RCTs on PR is impaired.
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If the incomplete post-intervention data are considered to reflect the overall dropout rate for this pilot study, then the range for different outcomes (6MWD, SGRQ score) falls within previously reported estimates for dropout/withdrawal rates of subjects in pulmonary rehabilitation programs (0-54%).
“If the incomplete post-intervention data are considered to reflect the overall dropout rate for this pilot study, then the range for different outcomes (6MWD, SGRQ score) falls within previously reported estimates for dropout/withdrawal rates of subjects in pulmonary rehabilitation programs (0 -54%).26”
From Cognitive behavioral therapy for management of dyspnea: A pilot study (2015) · cites this paper as [26]
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Experimental — accuracy not yet measuredExacerbations of chronic disease, lack of time, transport issues, motivation, and lack of perceived benefit of pulmonary rehabilitation are well documented as reasons for withdrawal or dropout in studies of pulmonary rehabilitation.
“Exacerbations of chronic disease, lack of time, transport issues, motivation, and lack of perceived benefit of pulmonary rehabilitation are well documented as reasons for withdrawal or dropout in studies of pulmonary rehabilitation.26,27”
From Cognitive behavioral therapy for management of dyspnea: A pilot study (2015) · cites this paper as [26]
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Pulmonary rehabilitation in clinical routine: A follow-up study
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- Authors
- Bjoernshave
- Affiliations
- Regional Hospital Horsens (DK)
- Corresponding author
- Bjoernshave
- Venue
- Clinical Epidemiology
- Publisher
- Informa UK Limited
- Published
- 2010-04
- Volume
- 2
- Pages
- 73
- ISSN
- 1179-1349 (ISSN-L)
- PMC
- PMC2943180
- OpenAlex
- W1992990516
- Cited by
- 44
- References
- 63
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 5
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Epidemiology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- pulmonary rehabilitation, chronic obstructive pulmonary disease, trial participant selection, participant dropout, sampling bias, generalizability, clinical implementation
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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