A prospective qualitative exploration of views about attending pulmonary rehabilitation

Bulley, Catherine; Donaghy, Marie; Howden, Stella; Salisbury, Lisa; Whiteford, Suzanne; Mackay, Elaine

doi:10.1002/pri.435

Cited by 49 publications

(54 citation statements)

References 20 publications

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“…Further, previous studies in “stable” population groups showed that an exacerbation or worsening of COPD symptoms was the primary reason for dropping out of a pulmonary rehabilitation program 41,42. Studies have also reported that fear and anxiety surrounding re-exacerbation restricts participation in physical activity and pulmonary rehabilitation 39–41,43,45. Participants in this study had recently experienced an exacerbation of symptoms requiring hospital admission, which may have been fresh in their minds, causing anxiety regarding re-exacerbation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

Thorpe¹,

Kumar²,

Johnston³

2014

COPD

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BackgroundChronic obstructive pulmonary disease (COPD) is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.MethodsThis study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.ResultsA plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness) environment-related (weather, transport, and finance), and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and “feeling better”.ConclusionThis research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is clear that health professionals dealing with people suffering from COPD need to actively recognize and address barriers to physical activity and pulmonary rehabilitation. Hospital admission may create an opportunity for implementation of interventions promoting physical activity (such as referral to pulmonary rehabilitation), which may assist in reducing hospital readmission, as well as decreasing morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

Thorpe¹,

Kumar²,

Johnston³

2014

COPD

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“…Second, patients who are being referred for prehabilitation should be given oral and written information about what this will entail and the potential benefits. Experience from pulmonary rehabilitation indicates that the uptake and effects of prehabilitation may be positively influenced by the initial clinician interaction and by what information is provided about the programme [23][24][25]. Initial discussions with the patient should also seek to identify their goals for prehabilitation, which should then be recorded, and may aid Figure 1 The prehabilitation concept.…”

Section: Background To Pre-operative Exercise Trainingmentioning

confidence: 99%

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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“…Patients who are likely to benefit from pulmonary rehabilitation have their exercise capacity limited by breathlessness or muscle fatigue and may have difficulty understanding the rationale behind referral for exercise training. From qualitative studies, success and outcome of rehabilitation are positively influenced by the initial clinician interaction and detail provided about pulmonary rehabilitation 52 53. Studies report that lack of understanding of the benefits of pulmonary rehabilitation may influence uptake 54 55.…”

Section: Evidencementioning

confidence: 99%

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

Bolton

Bevan-Smith

Blakey

et al. 2013

Thorax

536

324

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A prospective qualitative exploration of views about attending pulmonary rehabilitation

Cited by 49 publications

References 20 publications

Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE

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