Hug Sarah, Cavalheri Vinicius, Gucciardi Daniel F, Norman Richard, Hill Kylie
School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia.
Physiotherapy Department, Royal Perth Hospital, Perth, Australia.
BMC Pulm Med. 2020 Nov 2;20(1):286. doi: 10.1186/s12890-020-01322-4.
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterised by dyspnoea during daily life. As the disease progresses, people with COPD can experience poor quality of life, reduced exercise capacity, worsening of symptoms and increased hospital admissions. Pulmonary rehabilitation, which includes exercise training, optimises both psychological and physical function, reduces symptoms and mitigates healthcare utilisation in people with COPD. There is, however, a gap in implementation of pulmonary rehabilitation programs, with global access limited to a small fraction of people with COPD. The overall aim of this study is to gather evidence that will optimise the implementation of pulmonary rehabilitation in people with COPD living in Perth, Western Australia.
This is a mixed methods study protocol informed by a critical realist perspective. The study will comprise four phases. In Phase 1, we will quantify target behaviours of healthcare professionals and people with COPD which are related to the implementation of pulmonary rehabilitation at three tertiary hospitals. In Phase 2, we will conduct semi-structured interviews to explore the determinants of these target behaviours from the perspectives of healthcare professionals, people with COPD and their primary support person. In Phase 3, knowledge gained in Phases 1 and 2 will be used by healthcare professionals and people with COPD to co-create, field test and apply strategies that optimise these target behaviours. In Phase 4, we will re-quantify these target behaviours to determine the influence of co-created strategies. The cost effectiveness of implementing the co-created strategies will be explored by an economic analysis.
Understanding current clinical practice and the determinants of target behaviours pertaining to the implementation of pulmonary rehabilitation is crucial when developing strategies that successfully bridge the pulmonary rehabilitation implementation gap. If co-created strategies are effective, more people with COPD living in Perth, Western Australia will have access to pulmonary rehabilitation enabling them to derive the health benefits associated with this intervention.
慢性阻塞性肺疾病（COPD）是一种常见的呼吸系统疾病，其特征为日常生活中出现呼吸困难。随着疾病进展，慢性阻塞性肺疾病患者可能会出现生活质量下降、运动能力降低、症状加重以及住院次数增加等情况。肺康复包括运动训练，可优化慢性阻塞性肺疾病患者的心理和身体功能，减轻症状并减少医疗资源的使用。然而，肺康复项目的实施存在差距，全球范围内只有一小部分慢性阻塞性肺疾病患者能够获得该治疗。本研究的总体目标是收集证据，以优化西澳大利亚州珀斯市慢性阻塞性肺疾病患者的肺康复实施情况。
这是一项基于批判实在论视角的混合方法研究方案。该研究将包括四个阶段。在第一阶段，我们将量化医疗专业人员和慢性阻塞性肺疾病患者与三家三级医院肺康复实施相关的目标行为。在第二阶段，我们将进行半结构化访谈，从医疗专业人员、慢性阻塞性肺疾病患者及其主要支持人员的角度探索这些目标行为的决定因素。在第三阶段，医疗专业人员和慢性阻塞性肺疾病患者将利用在第一阶段和第二阶段获得的知识共同创建、实地测试并应用优化这些目标行为的策略。在第四阶段，我们将重新量化这些目标行为，以确定共同创建的策略的影响。将通过经济分析探讨实施共同创建的策略的成本效益。
在制定成功弥合肺康复实施差距的策略时，了解当前的临床实践以及与肺康复实施相关的目标行为的决定因素至关重要。如果共同创建的策略有效，更多居住在西澳大利亚州珀斯市的慢性阻塞性肺疾病患者将能够获得肺康复治疗，从而从中受益。
