Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework

Cox, Narelle S; Oliveira, Cristino Carneiro; Lahham, Aroub; Holland, Anne E

doi:10.1016/j.jphys.2017.02.002

Cited by 166 publications

(149 citation statements)

References 74 publications

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“…In studies conducted to date, current smoking, depression, social isolation, poor mobility, lack of perceived benefit, extremes of age, dyspnoea severity, long‐term oxygen therapy, transportation difficulty or travel distance, socio‐economic disadvantage and costs have been associated with non‐adherence and/or lack of programme completion . Despite these associations, many complex factors influence uptake, adherence to and completion of PR, and no individual adherence‐related parameters can be used reliably to predict consistently which people will complete the programme, hence patient candidacy for PR should not presently be based on these factors.…”

Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co‐morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of ‘responsiveness to PR’, to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health‐related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self‐efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.

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Section: Additional Considerations For Patient Selection For Prmentioning

confidence: 99%

Patient assessment and selection for pulmonary rehabilitation

Rochester

2019

Respirology

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“…Developed using a consensus approach, the TDF is a synthesis of 128 explanatory constructs from 33 theories of behaviour change and comprises of 14 theoretical domains (Cane, O'Connor, & Michie, 2012). The TDF has previously been applied in a variety of settings, including inpatient medicine (Duncan et al, 2012), community paediatrics (Seward et al, 2017) and rehabilitation (Cox, Oliveira, Lahham, & Holland, 2017). The framework has been used specifically in stroke rehabilitation to explore factors influencing the uptake of multiple stroke guideline recommendations (McCluskey et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework

Jolliffe

Hoffmann

Lannin

2019

Aus Occup Therapy J

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Introduction Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain ‘best practice’ recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified. Method To investigate occupational and physiotherapists’ perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed‐method study was conducted. Using an online survey and semi‐structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free‐text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework. Results Forty‐six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence. Conclusion Therapists identified that both motivators and barriers to implementing best‐practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change.

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“…These data suggest that despite our best efforts, the traditional pulmonary rehabilitation model has not been successful for the majority. The barriers to uptake and completion have not changed in over 20 years and are most frequently related to the burden of illness, travel to programmes and insufficient health system resources …”

mentioning

confidence: 99%

Pulmonary rehabilitation for chronic obstructive pulmonary disease: Has it peaked?

Holland

2018

Respirology

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Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework

Cited by 166 publications

References 74 publications

Patient assessment and selection for pulmonary rehabilitation

Patient assessment and selection for pulmonary rehabilitation

Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework

Pulmonary rehabilitation for chronic obstructive pulmonary disease: Has it peaked?

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