Barriers and facilitators to pulmonary rehabilitation in COPD: a mixed-methods systematic review

作者：Hua Qin, Ping Jia, Qilin Yan, Xi Li, Yan Zhang, Hong Jiang, Hongmei Yang, Linzhang Li · 发表于：BMC Pulmonary Medicine · 年份：2025 · DOI：10.1186/s12890-025-03769-9 · 被引用次数：20 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Respiratory Support and Mechanisms、Health and Wellbeing Research

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: PR...