The Impact of Patient Preference on Attendance and Completion Rates at Centre-Based and mHealth Pulmonary Rehabilitation: A Non-Inferiority Pragmatic Clinical Trial

Sarah Candy,1,2 Julie Reeve,2 Rosie Dobson,3,4 Robyn Whittaker,3,4 Jeffrey Garrett,1 Jim Warren,5 Amanda Calder,3 Taria Tane,3 Trina Robertson,4 Usman Rashid,2 Denise Taylor2 1Te Whatu Ora Counties Manukau Health, Auckland, New Zealand; 2Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand; 3National Institute for Health Innovation, University of Auckland, Auckland, New Zealand; 4Te Whatu Ora Waitematā, Auckland, New Zealand; 5School of Computer Science, University of Auckland, Auckland, New ZealandCorrespondence: Sarah Candy, Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Private Bag 93311, Otahuhu, Auckland, 1640, New Zealand, Tel +64274363116, Email scandy@middlemore.co.nzPurpose: Pulmonary rehabilitation (PR) is vital in the management of chronic respiratory disorders (CRDs) although uptake, attendance and completion are poor. Differing models of delivering PR are emerging in an attempt to increase the uptake and completion of this intervention. This study aimed to evaluate participant rate of attendance and completion of PR when given a preference regarding model of delivery (centre-based and mPR). Secondary aims were to evaluate the factors affecting patient preference for model of delivery and determine whether mPR is non-inferior to centre-based PR in health outcomes.Methods: A multi-centre non-inferiority preference based clinical trial in Auckland, New Zealand. Participants with a CRD referred for PR were offered the choice of centre-based or mHealth PR (mPR). The primary outcome was completion rate of chosen intervention.Results: A total of 105 participants were recruited to the study with 67 (64%) preferring centre-based and 38 (36%) mPR. The odds of completing the PR programme were higher in the centre-based group compared to mPR (odds ratio 1.90 95% CI [0.83– 4.35]). Participants opting for mPR were significantly younger (p = 0.002) and significantly more likely to be working (p = 0.0001). Results showed that mPR was not inferior to centre-based regarding changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ). When services were forced to transition to telehealth services during COVID-19 restrictions, the attendance and completion rates were higher with telephone calls and video conferencing compared to mPR – suggesting that synchronous interpersonal interactions with clinicians may facilitate the best attendance and completion rates.Conclusion: When offered the choice of PR delivery method, the majority of participants preferred centre-based PR and this facilitated the best completion rates. mPR was the preferred choice for younger, working participants suggesting that mPR may offer a viable alternative to centre-based PR for some participants, especially younger, employed participants.Keywords: chronic respiratory disorder, mHealth, preference, pulmonary rehabilitation, telehealth, telerehabilitation