A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients

Abstract EN

This retrospective study aimed to evaluate, through an ad hoc 17-item tool, the Pulmonary Rehabilitation Decisional Score (PRDS), the priority access to PR prescription by respiratory specialists.

The PRDS, scoring functional, clinical, disability, frailty, and participation parameters from 0 = low priority to 34 = very high priority for PR access, was retrospectively calculated on 124 specialist reports sent to the GP of subjects (aged 71 ± 11 years, FEV1% 51 ± 17 ) consecutively admitted to our respiratory outpatient clinic.

From the specialist’s report the final subject’s allocation could be low priority (LP) (>60 days), high priority (HP) (30–60 days), or very high priority (VHP) (<30 days) to rehabilitation.

The PRDS calculation showed scores significantly higher in VHP versus LP ( p < 0.001 ) and significantly different between HP and VHP ( p < 0.001 ).

Comparing the specialist’s allocation decision and priority choice based on PRDS cut-offs, PR prescription was significantly more appropriate in VHP than in HP ( p = 0.016 ).

Specialists underprescribed PR in 49% of LP cases and overprescribed it in 46% and 30% of the HP and VHP prescriptions, respectively.

A multicomprehensive score is feasible being useful for staging the clinical priorities for PR prescription and facilitating sustainability of the health system.