Qin Hua, Jia Ping, Yan Qilin, Li Xi, Zhang Yan, Jiang Hong, Yang Hongmei, Li Linzhang
Pulmonary and Critical Care Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Hospital Office, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
BMC Pulm Med. 2025 Jul 3;25(1):314. doi: 10.1186/s12890-025-03769-9.
This mixed-methods systematic review examines determinants influencing engagement in pulmonary rehabilitation (PR) among patients with chronic obstructive pulmonary disease (COPD) and synthesizes evidence to guide intervention strategies.
Following PRISMA guidelines, 29 studies (2006–2023) from eight databases were analyzed using the Joanna Briggs Institute (JBI) convergent integrated approach for data integration. The PRECEDE model categorized barriers into predisposing (psychological, health literacy), reinforcing (interpersonal dynamics), and enabling (structural) domains. Methodological quality was assessed with the Mixed Methods Appraisal Tool.
Psychological barriers, such as anxiety and low health literacy, significantly diminished motivation for rehabilitation. Interpersonal challenges revealed insufficient healthcare provider competencies-such as inadequate clinical guidance and communication gaps-which undermined therapeutic alliances and patient adherence. Family support enhanced participation but risked dependency without structured education. Structural inequities, particularly urban-rural resource disparities and financial constraints, systematically excluded vulnerable populations. Persistent smoking emerged as a critical behavioral barrier, reflecting both physiological and self-care challenges. Facilitators included trust in healthcare providers, accessible urban rehabilitation resources, and personalized care plans.
PR participation is governed by interacting psychological, interpersonal and structural factors that shift with care context. A six-domain implementation schema (mental-health screening, flexible access, tele-rehabilitation plus caregiver toolkits, clinician up-skilling, peer reinforcement and targeted economic support) provides actionable leverage to lessen barriers and strengthen facilitators. Empathic, two-way communication among professionals, patients and families remains pivotal to converting exercise prescriptions into durable self-management. Future research should test the effectiveness and cost-utility of this integrated package across settings and further refine digital tools for tailoring programme intensity and follow-up.
The online version contains supplementary material available at 10.1186/s12890-025-03769-9.
本混合方法系统评价探讨影响慢性阻塞性肺疾病（COPD）患者参与肺康复（PR）的决定因素，并综合证据以指导干预策略。
遵循PRISMA指南，使用乔安娜·布里格斯研究所（JBI）的收敛性综合方法对来自八个数据库的29项研究（2006 - 2023年）进行数据分析，以整合数据。PRECEDE模型将障碍分为促成因素（心理、健康素养）、强化因素（人际动态）和使能因素（结构）领域。使用混合方法评估工具评估方法学质量。
心理障碍，如焦虑和健康素养低，显著降低了康复动机。人际挑战表明医疗保健提供者能力不足，如临床指导不足和沟通差距，这破坏了治疗联盟和患者依从性。家庭支持提高了参与度，但在没有结构化教育的情况下有产生依赖的风险。结构不平等，特别是城乡资源差距和经济限制，系统性地排除了弱势群体。持续吸烟成为一个关键的行为障碍，反映了生理和自我护理方面的挑战。促进因素包括对医疗保健提供者的信任、可及的城市康复资源和个性化护理计划。
PR参与受心理、人际和结构因素相互作用的影响，这些因素会随护理环境而变化。一个六领域实施方案（心理健康筛查、灵活获取、远程康复加护理人员工具包、临床医生技能提升、同伴强化和有针对性的经济支持）提供了可采取行动的杠杆作用，以减少障碍并加强促进因素。专业人员、患者和家庭之间富有同理心的双向沟通对于将运动处方转化为持久的自我管理仍然至关重要。未来的研究应测试这一综合方案在不同环境中的有效性和成本效益，并进一步完善数字工具以调整项目强度和随访。
在线版本包含可在10.1186/s12890 - 025 - 03769 - 9获取的补充材料。
