促进或阻碍患者参与肺和心脏康复的因素:快速评估制图回顾。

Lindsay Blank, Anna Cantrell, Katie Sworn, Andrew Booth
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引用次数: 0

摘要

背景:有相当多的系统评价证据考虑康复计划对临床结果的有效性。然而,对于如何有效地让患者参与和维持康复,我们所知甚少。有必要了解所有可能的干预策略。方法:我们对2017-21年发表的英国综述级证据进行了制图回顾。我们检索了MEDLINE、EMBASE和护理与相关健康累积指数(CINAHL),并进行了叙述综合。纳入了影响心肺康复开始、继续或完成的因素,或促进这些因素的干预措施的综述。研究选择由两位审稿人独立进行。结果:我们总共确定了20篇符合纳入标准的综述论文。有16篇偏向于考虑心脏康复的综述。通过对关键网站的互联网搜索,还确定了另外11种未发表的干预措施。这些综述包括60项可识别的英国主要研究,这些研究考虑了影响康复出勤率的因素;42人考虑心脏康复,18人考虑肺康复。他们从患者的角度以及参与转诊或治疗的专业人员的角度报告了因素。更常见的是,报告的因素是阻碍而不是促进康复。我们将这些因素分为患者角度(支持、文化、人口统计、实践、健康、情感、知识/信仰和服务因素)和专业角度(知识:工作人员和患者、人员配备、服务提供的充分性和其他服务的转诊,包括支持和等待时间)。我们发现很少有评论(n = 3)关注促进康复参与的干预措施。虽然大多数影响参与的因素都是从患者的角度报告的,但从提供者的角度来看,实施了大多数确定的干预措施,以解决获取障碍。因此,确定的干预措施无法解决患者确定的大多数获取挑战。最近在COVID-19大流行期间实施的未经评估的干预措施可能会对患者在获得服务方面的一些障碍产生影响,包括旅行和服务时间不方便。结论:影响心肺康复开始、继续或完成的因素是一个复杂且相互关联的网络,考虑到患者和服务提供者的观点。我们确定的少数旨在改善可及性的已发表干预措施不太可能解决大多数这些因素,特别是那些被患者确定为限制其可及性的因素。更好地了解这些因素将使未来的干预措施更加以证据为基础,在如何解决改善获取的已知障碍方面有明确的目标。局限性:时间限制限制了对研究质量的考虑,并排除了其他搜索方法,如引文搜索和联系关键作者。这可能对所确定的证据基础的完整性产生影响。未来的工作:对有希望的干预措施进行高质量的有效性研究,以提高总体和关键患者群体的康复出勤率,应该成为未来的重点。资助:本报告介绍了由国家卫生研究所(NIHR)资助的独立研究。作者在本出版物中表达的观点和观点仅代表作者的观点和观点,并不一定反映NHS、NIHR、NETSCC、HSDR计划或卫生部的观点和观点。研究注册:研究方案已在PROSPERO注册[CRD42022309214]。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review.

Background: There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies.

Methods: We conducted a mapping review of UK review-level evidence published 2017-21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers.

Results: In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients' point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (n = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services.

Conclusions: The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these factors, especially those identified by patients as limiting their access. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access.

Limitations: Time limitations constrained the consideration of study quality and precluded the inclusion of additional searching methods such as citation searching and contacting key authors. This may have implications for the completeness of the evidence base identified.

Future work: High-quality effectiveness studies of promising interventions to improve attendance at rehabilitation, both overall and for key patient groups, should be the focus moving forward.

Funding: This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HSDR programme or the Department of Health.

Study registration: The study protocol is registered with PROSPERO [CRD42022309214].

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