Pulmonary Rehabilitation: Overwhelming Evidence but Lost in Translation?

被引:73
作者
Johnston, Kylie [1 ]
Grimmer-Somers, Karen [1 ]
机构
[1] Univ S Australia, Sansom Inst Hlth Res, Int Ctr Allied Hlth Evidence, Adelaide, SA 5001, Australia
关键词
COPD; evidence translation; guidelines; implementation; pulmonary rehabilitation; PRIMARY-CARE; DISEASE; MANAGEMENT; PREDICTORS; GUIDELINES; ADHERENCE; COPD; PROGRAMS; EXERCISE; PART;
D O I
10.3138/physio.62.4.368
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Purpose: This report highlights the current international gap between the availability of high-quality evidence for pulmonary rehabilitation (PR) and its low level of implementation. Key barriers are outlined, and potentially effective strategies to improve implementation are presented. Summary of key points: Although pulmonary rehabilitation (PR) is recommended by international guidelines as part of the management of patients with chronic obstructive pulmonary disease (COPD), participation in PR remains low. Physician referral to PR ranges from 3% to 16% of suitable patients. Barriers to participation include limited availability of suitable programmes and interrelated issues of referral and access. Individual patient barriers, including factors relating to comorbidities and exacerbations, perceptions of benefit, and ease of access, contribute less overall to low participation rates. Chronic care programmes that incorporate self-management support have some benefit in patients with COPD. However, the demonstrated cost-effectiveness of PR is substantial, and efforts to improve its implementation are urgently indicated. Conclusion: To improve implementation, a holistic examination of the key issues influencing a patient's participation in PR is needed. Such an examination should consider the relative influences of environmental (e.g., health-service-related) factors, organizational factors (e.g., referral and intake procedures), and individual factors (e.g., patient barriers) for all participants. On the basis of these findings, policy, funding, service delivery, and other interventions to improve participation in PR can be developed and evaluated.
引用
收藏
页码:368 / 373
页数:6
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