A Pulmonary Rehabilitation Decisional Score to Define Priority Access for COPD Patients
Table 1
Pulmonary Rehabilitation Decisional Score (PRDS).
ITEMS
Score
0
1
2
Age, years
≤59
60–74
≥75
BMI, Kg/m2
21–24
25–30
≤20 or ≥31
FEV1% pred.
≥65%
36–64%
≤35%
Dyspnea, MRC score (0–4)
0-1
=2
≥3
6MWT, meters
≥350
≤349 and ≥250
≤249
CAT score
≤9
10–15
≥16
Comorbidities
0
1
1 if cardiac/neurological or >1
Activity of daily life
Normal
Limited
Bedridden/wheelchair-restricted
Severe exacerbations in the last year
0
1
>1
Hospitalizations in the last year
0
0, but 1 ER access
>0 or 2 ER access instances
Smoking status
Nonsmoker
Ex-smoker
Current smoker
Physical activity (cyclette, walking, steps)
>4 h/week
2–4 h/week
<2 h/week
Subjective wellbeing
Very well/good
Poor
bad
Depression
No medications
Occasional medications
Under chronic therapy
Anxiety
No medications
Occasional medications
Under chronic therapy
Care need and availability
Not necessary
Useful and available full time
Useful but available on spot or unavailable
Adherence to medications/oxygen
Full
Not constant
Poor/refusal to comply
FEV1 = forced expiratory volume at first second; MRC = Medical Research Council; ER = emergency room; W = week; BMI = body mass index; CAT = COPD Assessment Tool; 6MWT = 6-min walking test. Consensus was considered when more than 75% of the respondents (a) rated each item as mandatory to be inserted in the score when considered “important” and/or “very important” and (b) agreed to each item’s grading from 0 = minimum to 2 = maximum priority indication for PR. Exacerbation was defined as “an event requiring antibiotics and/or oral steroids as prescribed by specialist or patient’s GP.”