School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Centre for Health Outcomes Research, and.
Ann Am Thorac Soc. 2019 Sep;16(9):1158-1164. doi: 10.1513/AnnalsATS.201812-854OC.
Current international guidelines for prevention of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) recommend enrolment and participation in a pulmonary rehabilitation (PR) program within 4 weeks of hospital discharge. However, there is poor uptake of these programs as well as low adherence and completion rates. The objectives of this study were to explore the views of patients and healthcare professionals (HCPs) on PR after AECOPD and how participation could be enhanced. A qualitative study was undertaken, and data were analyzed using deductive thematic analysis. A total of 13 patients who had experienced an AECOPD in the previous 6 months and 11 HCPs experienced in the management of COPD participated in face-to-face, semistructured interviews. Patients and HCPs were recruited from both rehabilitation and acute hospital settings. Four main themes were identified: ) uncertainty about timing of PR-most HCPs endorsed the professional guidelines that advocate for PR programs to begin within 4 weeks of an AECOPD; patients, however, varied drastically in their view of the ideal timing to start a PR program, anywhere from before an exacerbation (perhaps preventing one) and up to 6-8 weeks after exacerbation; ) tailored and flexible manner to deliver PR programs with a gradual start-patients and HCPs talked about individually tailored programs with a gradual introduction of exercise and teaching sessions; some HCPs advocated allowing patients to pick and choose which elements would help them the most; ) education for all-patients would like HCPs to be more informed and informative about the PR programs available in their neighborhoods, and HCPs focused on how they could educate patients about their disease and how better to manage it; and ) logistical, disease-related, and psychological barriers-barriers to PR were discussed by both HCPs and patients; these fell into two categories: ) delivery issues (i.e., transportation and location of PR); and ) patient-specific issues (too sick or too well, high levels of anxiety). Our findings lay the foundation for the development of a flexible, stepped-care approach to delivering PR after AECOPD, which should be tailored according to the needs and preferences of the individual.
目前，国际上针对慢性阻塞性肺疾病急性加重（AECOPD）的预防指南建议，患者在出院后 4 周内参加肺康复（PR）项目。然而，这些项目的参与率很低，患者的依从性和完成率也很低。本研究的目的是探讨 AECOPD 后患者和医疗保健专业人员（HCPs）对 PR 的看法，以及如何提高参与度。本研究采用定性研究方法，使用演绎主题分析对数据进行分析。共有 13 名在过去 6 个月内经历过 AECOPD 的患者和 11 名在 COPD 管理方面经验丰富的 HCPs 参与了面对面的半结构化访谈。患者和 HCPs 分别从康复和急性医院环境中招募。确定了四个主要主题：）对 PR 时间的不确定性——大多数 HCPs 认可专业指南，即提倡在 AECOPD 后 4 周内开始 PR 项目；然而，患者对开始 PR 项目的理想时间有很大的不同，从加重前（也许可以预防一次）到加重后 6-8 周不等；）以量身定制和灵活的方式提供 PR 项目，逐步开始——患者和 HCPs 谈到了个性化的项目，逐步引入运动和教学课程；一些 HCPs 主张让患者选择最能帮助他们的元素；）全员教育——患者希望 HCPs 对他们所在社区提供的 PR 项目有更多的了解和信息，HCPs 则专注于如何教育患者了解他们的疾病以及如何更好地管理疾病；）后勤、疾病相关和心理障碍——HCPs 和患者都讨论了 PR 的障碍；这些障碍分为两类：）交付问题（即 PR 的交通和地点）；）患者特定问题（病得太重或太轻，焦虑水平高）。我们的研究结果为在 AECOPD 后提供灵活的、分阶段的 PR 方法奠定了基础，这种方法应该根据个人的需求和偏好进行定制。
