{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:54:46Z","timestamp":1791356086117,"version":"4.3.1"},"reference-count":31,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>There are no descriptions of the \"ideal candidate\" or validated indices to justify admitting respiratory patients to hospital-based rehabilitation. This study aimed to quantify appropriate\/inappropriate admissions to in-hospital rehabilitation programs among respiratory patients. We analyzed hospitalization records from the ICS Maugeri repository (01 January 2015 - 31 December 2024) across seven Italian ICS Maugeri centers. Patients were categorized as chronic respiratory failure (CRF; 45.70%), chronic obstructive pulmonary disease (COPD; 22.76%), asthma (0.07%), obstructive sleep apnea (OSAS; 10.89%), and miscellaneous dyspnea not related to COPD (19.84%).\nAnthropometric, Cumulative Illness Rating Scale, Medical Research Council (MRC) scale, Barthel dyspnea, COPD Assessment Test (CAT), 6-minute walk test (6MWT), and Short Physical Performance Battery (SPPB) were collected. Appropriateness of hospital admission was defined according to literature-based severity cut-offs for all disability items, while inappropriateness was computed on four contemporary items (excluding MRC). The cohort was predominantly male, aged 60-70 years, with CRF (46%) and multiple comorbidities; most (84%) were admitted from home, while &gt;95% of patients returned home. High overall appropriateness in the whole group was 73-87% across items, with the highest % for 6MWT predicted across all TPs (74% OSAS-94% CRF) and lower for SPPB (60% OSAS-78% CRF) and for the MRC dyspnea score (75% OSAS-89% CRF).\nThe CRF group demonstrated very high appropriateness (&gt;78% in all items), COPD presented strong appropriateness for deconditioning (6MWT: 83%) dyspnea (MRC: 84%), asthma patients showed a lower CAT appropriateness (64%). The OSAS subgroup had the lowest entry appropriateness (55-74%). The dyspnea group exhibited high appropriateness for deconditioning (6MWT: 83%) and for dyspnea (MRC: 81%, Barthel dyspnea: 81%). Among 6086 complete cases, only 2.8% were deemed to be inappropriate admissions. The highest inappropriateness was in the dyspnea subgroup (6%), while the lowest was for CRF (0.7%).\u00a0 Entry appropriateness was high or very high for overall items, showing 6MWT the best rate and CAT and SPPB the worst. CRF patients showed the highest appropriateness, while the rate of inappropriateness was overall low, with dyspnea and OSAS subgroups the worst and CRF the best. Future strategies must focus on developing standardized, multifaceted evaluation tools to objectively guide inpatient rehabilitation referrals.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4012","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:36:01Z","timestamp":1791354961000},"source":"Crossref","is-referenced-by-count":0,"title":["Appropriateness\/inappropriateness of access to an in-hospital rehabilitation program for patients with respiratory disease"],"prefix":"10.4081","author":[{"given":"Sabrina","family":"Fenaroli","sequence":"first","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3982-2098","authenticated-orcid":false,"given":"Mara","family":"Paneroni","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-9921","authenticated-orcid":false,"given":"Mauro","family":"Maniscalco","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Benevento; Department of Clinical Medicine and Surgery, University of Naples Federico II"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3595-9903","authenticated-orcid":false,"given":"Antonio","family":"Spanevello","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Varese; MACRO, University of Insubria, Tradate, Varese"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5478-8521","authenticated-orcid":false,"given":"Mauro","family":"Carone","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Bari; Department of Medical and Surgical Science, University of Foggia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0393-0409","authenticated-orcid":false,"given":"Giuseppina","family":"Cassetti","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Milano"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0690-695X","authenticated-orcid":false,"given":"Cinzia","family":"Lastoria","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Pavia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5933-1398","authenticated-orcid":false,"given":"Rodolfo","family":"Murgia","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9389-7915","authenticated-orcid":false,"given":"Michele","family":"Vitacca","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"88066","unstructured":"Cartabellotta A. Governo clinico o clinical governance? Leggendo tra le righe del nuovo Ddl sul tema. GIMBEnews 2009;3:1. [Article in Italian]."},{"key":"88067","unstructured":"Cacciatore P, Sisti LG, Frsicale EM, et al. Value based Healthcare: operative solutions for the revitalization and growth of the Italian National Health Service Report of the High-level Health Policy Workshop \u2013 May 11th 2017 (Rome). GIHTAD 2018;11:3. [Article in Italian]."},{"key":"88068","doi-asserted-by":"crossref","unstructured":"Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q 2005;83:691-729.","DOI":"10.1111\/j.1468-0009.2005.00397.x"},{"key":"88069","doi-asserted-by":"crossref","unstructured":"Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 2023;208:e7-26.","DOI":"10.1164\/rccm.202306-1066ST"},{"key":"88070","doi-asserted-by":"crossref","unstructured":"Cheng SWM, McKeough ZJ, McNamara RJ, Alison JA. Pulmonary rehabilitation using minimal equipment for people with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Phys Ther 2023;103:pzad013.","DOI":"10.1093\/ptj\/pzad013"},{"key":"88071","doi-asserted-by":"crossref","unstructured":"Eisner MD, Anthonisen N, Coultas D, et al, Environmental and occupational health assembly. An official American Thoracic Society public policy statement: novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010;182:693-718.","DOI":"10.1164\/rccm.200811-1757ST"},{"key":"88072","unstructured":"Presidenza del Consiglio dei Ministri, Italian Ministry of Health. Criteri di appropriatezza dell\u2019accesso ai ricoveri di riabilitazione ospedaliera and Linee di indirizzo per l\u2019individuazione di percorsi appropriati nella rete di riabilitazione. Rome: Italian Ministry of Health; 2021. Prot. DAR11216. Available from: https:\/\/www.quotidianosanita.it\/allegati\/allegato2957117.pdf"},{"key":"88073","doi-asserted-by":"crossref","unstructured":"van Dijk M, Gan CT, Koster TD, et al. Treatment of severe stable COPD: the multidimensional approach of treatable traits. ERJ Open Res 2020;6:00322-2019.","DOI":"10.1183\/23120541.00322-2019"},{"key":"88074","doi-asserted-by":"crossref","unstructured":"Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968;16:622-6.","DOI":"10.1111\/j.1532-5415.1968.tb02103.x"},{"key":"88075","doi-asserted-by":"crossref","unstructured":"Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580-6.","DOI":"10.1378\/chest.93.3.580"},{"key":"88076","doi-asserted-by":"crossref","unstructured":"Vitacca M, Malovini A, Balbi B, et al. Minimal clinically important difference in barthel index dyspnea in patients with COPD. Int J Chron Obstruct Pulmon Dis 2020;15:2591-9.","DOI":"10.2147\/COPD.S266243"},{"key":"88077","doi-asserted-by":"crossref","unstructured":"Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test. Eur Respir J 2009;34:648-54.","DOI":"10.1183\/09031936.00102509"},{"key":"88078","doi-asserted-by":"crossref","unstructured":"Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society\/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46.","DOI":"10.1183\/09031936.00150314"},{"key":"88079","doi-asserted-by":"crossref","unstructured":"Stoffels AA, De Brandt J, Meys R, et al. Short Physical Performance Battery: response to pulmonary rehabilitation and minimal important difference estimates in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2021;102:2377-84.e5. Erratum in: Arch Phys Med Rehabil 2022;103:2068-72.","DOI":"10.1016\/j.apmr.2022.07.001"},{"key":"88080","doi-asserted-by":"crossref","unstructured":"Souto-Miranda S, Rocha V, Mendes MA, et al. The presence of extra-pulmonary treatable traits increases the likelihood of responding to pulmonary rehabilitation. Respir Med 2023;206:107086.","DOI":"10.1016\/j.rmed.2022.107086"},{"key":"88081","unstructured":"Smid DE, Franssen FME, Gonik M, et al. Redefining cut-points for high symptom burden of the global initiative for chronic obstructive lung disease classification in 18,577 patients with chronic obstructive pulmonary disease. J Am Med Dir Assoc 2017;18:1097.e11-e24."},{"key":"88082","doi-asserted-by":"crossref","unstructured":"Koolen EH, van Hees HW, van Lummel RC, et al. \"Can do\" versus \"do do\": a novel concept to better understand physical functioning in patients with chronic obstructive pulmonary disease. J Clin Med. 2019;8:340.","DOI":"10.3390\/jcm8030340"},{"key":"88083","doi-asserted-by":"crossref","unstructured":"Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014;311:2387-96.","DOI":"10.1001\/jama.2014.5616"},{"key":"88084","doi-asserted-by":"crossref","unstructured":"Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:19-38.","DOI":"10.1164\/rccm.200408-1109SO"},{"key":"88085","doi-asserted-by":"crossref","unstructured":"Langer D, Hendriks E, Burtin C, et al. A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence. Clin Rehabil 2009;23:445-62.","DOI":"10.1177\/0269215509103507"},{"key":"88086","doi-asserted-by":"crossref","unstructured":"Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: joint ACCP\/AACVPR evidence-based clinical practice guidelines. Chest131:4S-42S.","DOI":"10.1378\/chest.06-2418"},{"key":"88087","unstructured":"Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society\/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64. Erratum in: Am J Respir Crit Care Med 2014;189:1570."},{"key":"88088","doi-asserted-by":"crossref","unstructured":"Troosters T, Demeyer H, Hornikx M, et al. Pulmonary rehabilitation. Clin Chest Med 2014;35:241-9.","DOI":"10.1016\/j.ccm.2013.10.006"},{"key":"88089","doi-asserted-by":"crossref","unstructured":"Rochester CL, Vogiatzis I, Holland AE, et al. An Official American Thoracic Society\/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med 2015;192:1373-86.","DOI":"10.1164\/rccm.201510-1966ST"},{"key":"88090","doi-asserted-by":"crossref","unstructured":"Spruit MA, Pitta F, Garvey C, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J 2014;43:1326-37.","DOI":"10.1183\/09031936.00145613"},{"key":"88091","doi-asserted-by":"crossref","unstructured":"Ambrosino N, Clini EM. Response to pulmonary rehabilitation: toward personalised programmes? Eur Respir J 2015;46:1538-40.","DOI":"10.1183\/13993003.01125-2015"},{"key":"88092","doi-asserted-by":"crossref","unstructured":"Wouters EFM, Wouters BBREF, Augustin IML, et al. Personalised pulmonary rehabilitation in COPD. Eur Respir Rev 2018 ;27:170125.","DOI":"10.1183\/16000617.0125-2017"},{"key":"88093","doi-asserted-by":"crossref","unstructured":"Vitacca M, Comini L, Barbisoni M, et al. A pulmonary rehabilitation decisional score to define priority access for COPD patients. Rehabil Res Pract 2017;2017:5710676.","DOI":"10.1155\/2017\/5710676"},{"key":"88094","doi-asserted-by":"crossref","unstructured":"Rehabilitation Complexity Scale for respiratory patients - Italian network. Is the rehabilitation complexity scale useful in individuals undergoing in-hospital pulmonary rehabilitation? Arch Phys Med Rehabil 2024;105:2150-59.","DOI":"10.1016\/j.apmr.2024.07.009"},{"key":"88095","doi-asserted-by":"crossref","unstructured":"Vitacca M, Paneroni M, Braghiroli A, et al. Exercise capacity and comorbidities in patients with obstructive sleep apnea. J Clin Sleep Med 2020;16:531-8.","DOI":"10.5664\/jcsm.8258"},{"key":"88096","doi-asserted-by":"crossref","unstructured":"Uzzaman MN, Agarwal D, Chan SC, et al. Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. Eur Respir Rev 2022;31:220076.","DOI":"10.1183\/16000617.0076-2022"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4012\/2285","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4012\/2285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:36:15Z","timestamp":1791354975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/4012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":31,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.4012","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}