What are the predictors and reasons for refusing to engage in a maintenance pulmonary rehabilitation program?

While the relevance and efficacy of maintenance pulmonary rehabilitation programs (M-PRP) are globally demonstrated, their generalization remains unsure. Indeed, M-PRP refusal is high (e.g. 40%, Wooton et al. 2017), questioning the external validity of these results. The study thus aimed to i) characterize the profile of patients who refuse to integrate a M-PRP, and ii) define the predictors and the reasons for refusal. The study population comprised patients contacted during a PRP between Fev. and Nov. 2023 to integrate a 12-month M-PRP with a digital platform and videoconference follow-up (RCT mRehab-COPD, <ext-link>NCT04550741</ext-link>). Clinical and sociodemographic characteristics, digital (MDPQ-16) and health (HLS-EUQ16) literacy, illness acceptance (AIS), fear of failure (PFAI), personality traits (BFI-10), anxiety-depression (HADS) and reasons for refusal (only for the refusers) were studied. 136 patients were included: 78 accepted and 58 refused (43%) the M-PRP. The probability of refusal was associated with low FEV₁ (OR=0.33, p=.02), low MDPQ-16 score (OR=0.97, p=.02) and low neuroticism (OR=0.51, p<.01). The main reasons for refusal were intention to practice regular physical activity (PA) alone (43%), constraint of the M-PRP (31%) and lack of IT facilities (29%). Severity of the disease and digital literacy are consistent barriers to acceptance of M-PRP. The association between low neuroticism (N-) and refusal is consistent with the high intention to practice PA alone in the refusers, given that N- are generally more active than N+ people. Conversely, higher worries about their health and sensitivity to threat could explain the higher likelihood to accept the M-PRP in N+ people.