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Obesity hypoventilation syndrome (OHS) is characterised by a body mass index of >30 kg/m2, with either diurnal or nocturnal hypoventilation in the absence of any other explanation for this.1 If left untreated, OHS can be associated with significant morbidity and mortality. Currently, the mainstay of treatment for OHS is non-invasive ventilation. Pulmonary rehabilitation (PR) is an established form of treatment for patients with chronic obstructive pulmonary disease (COPD).2 PR is increasingly offered to patients with various other chronic respiratory diseases, and a similar programme with particular emphasis on obesity can reasonably be expected to benefit patients with OHS.
At Papworth hospital, we have been interested in developing a multidisciplinary rehabilitation programme for patients with OHS and performed a questionnaire-based survey investigating the likelihood of patients participating in such a programme.
Patients were identified from the hospital database. A letter outlining the proposed rehabilitation programme (visiting the hospital twice a week for 8–12 weeks for a series of sessions involving supervised exercise, dietary advice and educational classes) and a short anonymous questionnaire were sent to 96 patients with OHS. The questionnaire required the patients to specify how likely they would be to attend the programme, if offered, and the reasons that might prevent them from attending. The patients were also asked if they would be more likely to attend the rehabilitation if travel was arranged and, if so, whether they would prefer the hospital to arrange transport or to be reimbursed for their own arrangements. The questionnaire included a section for any comments patients had.
Forty-six (48%) patients returned the questionnaire. Of these responses, 14 (30%) patients would either be “very likely” or “likely” to attend the rehabilitation programme, with 20 (43%) patients being “not at all” likely to attend. Travelling to the hospital was found to be the most significant concern amongst the group, with 27 (59%) patients saying the distance or travelling involved would prevent them from attending the programme. Out of these 27 patients, 11 (41%) would still not attend if their travel was arranged for them. Inconvenience (9%) and lack of spare time (13%) were also cited as reasons that prevented participation in the programme. Travelling was mentioned most frequently (37%) as well as patients reporting that the proposed rehabilitation programme would conflict with existing commitments such as work or child care (24%), that it would be more convenient if carried out in a local healthcare facility (13%) and that they needed more information in order to decide whether to attend (11%).
Given that the most common concern amongst patients was the travel required to attend the programme, one might predict that offering to help patients with their travel arrangements would increase the likelihood of attending rehabilitation. However, despite offering two options of travel assistance—arranged by the hospital or reimbursement for their own arrangements—41% of patients would still not attend.
This survey suggests that patients with OHS are poorly motivated to attend a rehabilitation programme. Providing more information about the benefits of exercise and diet-based interventions and a local service with adequate travel arrangements may increase the attendance at such programmes.
Competing interests None.
Provenance and Peer review Not commissioned; not externally peer reviewed.