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是什么阻止慢性阻塞性肺疾病患者参加肺康复?系统评价。

What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review.

机构信息

Department of Physiotherapy, Alfred Hospital, Melbourne, Australia.

出版信息

Chron Respir Dis. 2011;8(2):89-99. doi: 10.1177/1479972310393756.

Abstract

Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence. Despite this, many people with COPD do not complete their program or choose not to attend at all. The aim of this study was to determine the factors associated with uptake and completion of pulmonary rehabilitation for people with COPD. Seven electronic databases were searched for qualitative or quantitative studies that documented factors associated with uptake and completion of pulmonary rehabilitation in people with COPD. Two reviewers independently extracted data, which was synthesized to provide overall themes. Travel and transport were consistently identified as barriers to both uptake and completion. A lack of perceived benefit of pulmonary rehabilitation also influenced both uptake and completion. The only demographic features that consistently predicted non-completion were being a current smoker (pooled odds ratio 0.17, 95% confidence interval 0.10 to 0.32) and depression. The limited data available regarding barriers to uptake indicated that disruption to usual routine, influence of the referring doctor and program timing were important. In conclusion poor access to transport and lack of perceived benefit affect uptake of pulmonary rehabilitation. Current smokers and patients who are depressed are at increased risk of non-completion. Enhancing attendance in pulmonary rehabilitation will require more attention to transportation, support for those at risk of non-completion and greater involvement of patients in informed decisions about their care.

摘要

肺康复是慢性阻塞性肺疾病(COPD)患者治疗的重要组成部分,有充分的科学证据支持。尽管如此,许多 COPD 患者并未完成其康复计划,或根本不参加。本研究旨在确定与 COPD 患者接受和完成肺康复相关的因素。我们在七个电子数据库中搜索了定性或定量研究,这些研究记录了与 COPD 患者接受和完成肺康复相关的因素。两位评审员独立提取数据,然后综合数据以提供总体主题。出行和交通一直是影响接受和完成肺康复的障碍。对肺康复益处的感知不足也会影响接受和完成。唯一能一致预测未完成的人口统计学特征是当前吸烟(合并优势比 0.17,95%置信区间 0.10 至 0.32)和抑郁。关于接受障碍的有限数据表明,日常生活规律的打乱、转诊医生的影响和方案时间安排是重要因素。总之,交通不便和对益处的感知不足会影响肺康复的接受程度。目前吸烟和抑郁的患者更有可能无法完成康复计划。为了提高肺康复的出勤率,需要更加关注交通问题,为有较高不完成风险的患者提供支持,并让患者更多地参与有关其治疗的知情决策。

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