Desveaux Laura, Janaudis-Ferreira Tania, Goldstein Roger, Brooks Dina
1Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada.
COPD. 2015 Apr;12(2):144-53. doi: 10.3109/15412555.2014.922066. Epub 2014 Jul 1.
Despite the strong evidence base, the perception remains that the provision of pulmonary rehabilitation (PR) services are extremely limited. Imbalances in PR delivery give rise to unnecessary health costs and underserviced populations. We conducted a systematic review to characterize the international provision of PR, comparing its structure and delivery across countries, and gaining insight into the availability of PR in relation to geographical prevalence.
Electronic databases were searched from inception to September 2013 using the key words "pulmonary rehabilitation" and "survey." Two authors independently reviewed studies and assessed study quality. Data was extracted and double-checked to ensure accuracy.
The majority of programs (55-99%) were offered in an outpatient setting with the exception of Ireland, where the majority of programs were offered in the community (65%). Exercise was the primary component across all programs (77-100%), followed by education (74-100%). Physical therapists were the most common member of the PR team (49-100%). Functional walk tests were the most frequently used outcome measure, although the specific test utilized varied across countries. The current availability of PR services ≤1.2% of individuals with COPD.
Components provided in PR are similar, irrespective of country, while patient outcome measures demonstrated variation across countries. Recent surveys report the use of community resources for the delivery of PR programs, although the majority are outpatient based. The small number of potential individuals enrolled in PR suggests that an international increase in access and capacity would improve quality of life and reduce healthcare utilization in this population.
尽管有强有力的证据基础，但人们仍然认为肺康复（PR）服务的提供极为有限。PR服务提供的不均衡导致了不必要的医疗成本和服务不足的人群。我们进行了一项系统综述，以描述PR在国际上的提供情况，比较各国的结构和提供方式，并深入了解PR的可及性与地理患病率的关系。
从数据库建立至2013年9月，使用关键词“肺康复”和“调查”检索电子数据库。两位作者独立审查研究并评估研究质量。提取数据并进行双重核对以确保准确性。
除爱尔兰外，大多数项目（55%-99%）在门诊环境中提供，在爱尔兰，大多数项目在社区中提供（65%）。运动是所有项目的主要组成部分（77%-100%），其次是教育（74%-100%）。物理治疗师是PR团队中最常见的成员（49%-100%）。功能步行测试是最常用的结局指标，尽管各国使用的具体测试有所不同。目前PR服务的可及性≤1.2% 的慢性阻塞性肺疾病患者。
无论国家如何，PR提供的组成部分相似，而患者结局指标在各国之间存在差异。最近的调查报道了利用社区资源提供PR项目，尽管大多数是以门诊为基础的。参与PR的潜在个体数量较少，这表明在国际上增加可及性和能力将改善该人群的生活质量并减少医疗保健的利用。
