Narelle S Cox1, Cristino C Oliveira2, Aroub Lahham1, Anne E Holland3. 1. Physiotherapy Department, La Trobe University; Institute for Breathing and Sleep, Melbourne, Australia. 2. Physiotherapy Department, La Trobe University; Federal University of Juiz de Fora - Campus GV, Minas Gerais, Brazil. 3. Physiotherapy Department, La Trobe University; Institute for Breathing and Sleep, Melbourne, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Australia.
Abstract
QUESTION: What are the barriers and enablers of referral, uptake, attendance and completion of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD)? DESIGN: Systematic review of qualitative or quantitative studies reporting data relating to referral, uptake, attendance and/or completion in pulmonary rehabilitation. PARTICIPANTS: People aged >18years with a diagnosis of COPD and/or their healthcare professionals. DATA EXTRACTION AND ANALYSIS: Data were extracted regarding the nature of barriers and enablers of pulmonary rehabilitation referral and participation. Extracted data items were mapped to the Theoretical Domains Framework (TDF). RESULTS: A total of 6969 references were screened, with 48 studies included and 369 relevant items mapped to the TDF. The most frequently represented domain was 'Environment' (33/48 included studies, 37% of mapped items), which included items such as waiting time, burden of illness, travel, transport and health system resources. Other frequently represented domains were 'Knowledge' (18/48 studies, including items such as clinician knowledge of referral processes, patient understanding of rehabilitation content) and 'Beliefs about consequences' (15/48 studies, including items such as beliefs regarding role and safety of exercise, expectations of rehabilitation outcomes). Barriers to referral, uptake, attendance or completion represented 71% (n=183) of items mapped to the TDF. All domains of the TDF were represented; however, items were least frequently coded to the domains of 'Optimism' and 'Memory'. The methodological quality of included studies was fair (mean quality score 9/12, SD 2). CONCLUSION: Many factors - particularly those related to environment, knowledge, attitudes and behaviours - interact to influence referral, uptake, attendance and completion of pulmonary rehabilitation. Overcoming the challenges associated with the personal and/or healthcare system environment will be imperative to improving access and uptake of pulmonary rehabilitation. TRIAL REGISTRATION: PROSPERO CRD42015015976. [Cox NS, Oliveira CC, Lahham A, Holland AE (2017) Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy 63: 84-93].
QUESTION: What are the barriers and enablers of referral, uptake, attendance and completion of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD)? DESIGN: Systematic review of qualitative or quantitative studies reporting data relating to referral, uptake, attendance and/or completion in pulmonary rehabilitation. PARTICIPANTS: People aged >18years with a diagnosis of COPD and/or their healthcare professionals. DATA EXTRACTION AND ANALYSIS: Data were extracted regarding the nature of barriers and enablers of pulmonary rehabilitation referral and participation. Extracted data items were mapped to the Theoretical Domains Framework (TDF). RESULTS: A total of 6969 references were screened, with 48 studies included and 369 relevant items mapped to the TDF. The most frequently represented domain was 'Environment' (33/48 included studies, 37% of mapped items), which included items such as waiting time, burden of illness, travel, transport and health system resources. Other frequently represented domains were 'Knowledge' (18/48 studies, including items such as clinician knowledge of referral processes, patient understanding of rehabilitation content) and 'Beliefs about consequences' (15/48 studies, including items such as beliefs regarding role and safety of exercise, expectations of rehabilitation outcomes). Barriers to referral, uptake, attendance or completion represented 71% (n=183) of items mapped to the TDF. All domains of the TDF were represented; however, items were least frequently coded to the domains of 'Optimism' and 'Memory'. The methodological quality of included studies was fair (mean quality score 9/12, SD 2). CONCLUSION: Many factors - particularly those related to environment, knowledge, attitudes and behaviours - interact to influence referral, uptake, attendance and completion of pulmonary rehabilitation. Overcoming the challenges associated with the personal and/or healthcare system environment will be imperative to improving access and uptake of pulmonary rehabilitation. TRIAL REGISTRATION: PROSPERO CRD42015015976. [Cox NS, Oliveira CC, Lahham A, Holland AE (2017) Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy 63: 84-93].
Authors: Jane S Watson; Peymane Adab; Rachel E Jordan; Alexandra Enocson; Sheila Greenfield Journal: Br J Gen Pract Date: 2020-03-26 Impact factor: 5.386
Authors: Gabriela R Oates; William T Harris; Hector H Gutierrez; Cathy Mims; Sarah B Rutland; Corilyn Ott; Soumya J Niranjan; Isabel C Scarinci; Susan C Walley Journal: Pediatr Pulmonol Date: 2020-06-08
Authors: Narelle S Cox; Simone Dal Corso; Henrik Hansen; Christine F McDonald; Catherine J Hill; Paolo Zanaboni; Jennifer A Alison; Paul O'Halloran; Heather Macdonald; Anne E Holland Journal: Cochrane Database Syst Rev Date: 2021-01-29
Authors: Peter K Lindenauer; Mihaela S Stefan; Penelope S Pekow; Kathleen M Mazor; Aruna Priya; Kerry A Spitzer; Tara C Lagu; Quinn R Pack; Victor M Pinto-Plata; Richard ZuWallack Journal: JAMA Date: 2020-05-12 Impact factor: 157.335
Authors: Narelle S Cox; Christine F McDonald; Jennifer A Alison; Ajay Mahal; Richard Wootton; Catherine J Hill; Janet Bondarenko; Heather Macdonald; Paul O'Halloran; Paolo Zanaboni; Ken Clarke; Deidre Rennick; Kaye Borgelt; Angela T Burge; Aroub Lahham; Bruna Wageck; Hayley Crute; Pawel Czupryn; Amanda Nichols; Anne E Holland Journal: BMC Pulm Med Date: 2018-05-15 Impact factor: 3.317
Authors: Aroub Lahham; Christine F McDonald; Ajay Mahal; Annemarie L Lee; Catherine J Hill; Angela T Burge; Narelle S Cox; Rosemary Moore; Caroline Nicolson; Paul O'Halloran; Rebecca Gillies; Anne E Holland Journal: Chron Respir Dis Date: 2017-09-04 Impact factor: 2.444