Association between Rehabilitation Access Barriers, Treatment Adherence, and Functional Status among Patients with COPD in Lahore, Pakistan: An Analytical Cross-Sectional Study

Abstract

Background: Pulmonary rehabilitation is an established component of chronic obstructive pulmonary disease (COPD) care, but logistical, financial, and symptom-related barriers may limit participation. Objective: To examine associations among rehabilitation access barriers, treatment adherence, and functional status in adults with COPD. Methods: An analytical cross-sectional study was conducted over six months at Ashraf Medical Centre, Sargodha, Pakistan. Sixty-two adults with COPD were selected using purposive sampling. Access burden was recorded using a research-developed 10-item score (0–30). Rehabilitation initiation and attendance, London Chest Activity of Daily Living (LCADL) score, six-minute walk distance (6MWD), and COPD Assessment Test (CAT) score were assessed. Spearman correlations, group comparisons, and exploratory multivariable regression were undertaken. Results: Rehabilitation was prescribed to 41/62 (66.1%) participants, of whom 27/41 (65.9%) initiated it. Mean attendance among prescribed participants was 45.0 ± 36.6%. Barrier scores were higher among non-initiators than initiators (18.50 ± 3.16 vs 12.63 ± 4.35; p<0.001). Higher barrier scores correlated with lower attendance (ρ=−0.733; p<0.001). After adjustment for age, FEV₁ percentage predicted, and dyspnea, each five-point increase in barrier score was associated with lower odds of initiation (adjusted odds ratio 0.18; 95% CI 0.05–0.64; p=0.008). Unadjusted relationships between barriers and functional outcomes were attenuated in adjusted linear models. Conclusion: Greater reported access burden was associated with poorer rehabilitation uptake and attendance. Associations with functional status were largely explained by measured clinical severity indicators and require cautious interpretation