Factors influencing pulmonary rehabilitation outcomes in patients with COPD:a systematic review based on the new CFIR framework_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WEI Jiaxin ¹ , HOU Shuanglong ¹ , HEI Peng ¹ ,  WANG Gang ²

1. Graduate Department, Xi’an Physical Education University, Xi’an 710068, Shaanxi, P. R. China;
2. School of Sports and Health Science, Xi’an Physical Education University, Xi’an 710068, Shaanxi, P. R. China;

Corresponding author：

WANG Gang, Email: wanggang778@126.com

Keywords：

Chronic obstructive pulmonary disease; Sports rehabilitation; Pulmonary rehabilitation; Promoting factors; hindrance

DOI：

10.7507/1671-6205.202312009

Video：

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Objective To systematically evaluate the factors affecting the curative effect of pulmonary rehabilitation in COPD patients,and to provide theoretical basis for the implementation of rehabilitation. Methods Literature on the influencing factors of pulmonary rehabilitation efficacy in COPD patients was systematically searched in PubMed,Web of Science,Medline,ProQuest,Embase,CNKI and Wanfang databases from August 30,2023. According to the inclusion and exclusion criteria of the literature,the factors influencing the pulmonary rehabilitation effect of COPD patients were analyzed based on the 5 dimensions of the new implementation comprehensive framework. Results A total of 2620 COPD patients with 18 literatures were included in this study. Based on the new CFIR framework,11 promoting factors and 10 hindering factors of pulmonary rehabilitation efficacy were extracted and coded into 5 fields:innovation field,external factor field,internal factor field,individual characteristics field and implementation process field. Conclusion By applying the new implementation comprehensive framework to evaluate the factors affecting the pulmonary rehabilitation effect of COPD patients,it provides an important reference for the development of rehabilitation strategies for COPD patients. It is suggested to adopt the comprehensive rehabilitation strategy of interdisciplinary,wide field and multi-team in order to promote the best benefit of both individual and social medical system in the pulmonary rehabilitation process of COPD patients.

Citation： WEI Jiaxin, HOU Shuanglong, HEI Peng, WANG Gang. Factors influencing pulmonary rehabilitation outcomes in patients with COPD:a systematic review based on the new CFIR framework. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(10): 703-709. doi: 10.7507/1671-6205.202312009 Copy

1.	Venkatesan P. GOLD COPD report: 2023 update. Lancet Respir Med, 2023, 11(1): 18.
2.	Vanfleteren LE, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013, 187(7): 728-735.
3.	World Health Organization. The Top 10 Causes of Death. Available online: https://www.who.int/news-room //fact-sheets/detail/the-top-10-causes-of-death.
4.	Hurst JR, Siddiqui MK, Singh B, et al. A systematic literature review of the humanistic burden of COPD. Int J Chron Obstruct Pulmon Dis, 2021, 16: 1303-1314.
5.	Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6.	Puhan MA, Scharplatz M, Troosters T, et al. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality–a systematic review. Respir Res, 2005, 6(1): 1-12.
7.	Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med, 2009, 151(4): W65-W94.
8.	Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated consolidated framework for implementation research based on user feedback. Implement Sci, 2022, 17(1): 75.
9.	Buchi ST, Villiger B, Sensky T, et al. Psychosocial predictors of long-term success of in-patient pulmonary rehabilitation of patients with COPD. Eur Respir J, 1997, 10(6): 1272-1277.
10.	Higashimoto Y, Yamagata T, Maeda K, et al. Influence of comorbidities on the efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int, 2016, 16(8): 934-941.
11.	Bentsen SB, Wentzel-Larsen T, Henriksen AH, et al. Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation—An exploratory study. Patient Educ Couns, 2010, 81(1): 5-13.
12.	段玉香, 范晔, 陈妍, 等. 影响慢性阻塞性肺疾病患者呼吸康复训练疗效的因素. 中国现代医学杂志, 2016, 26(20): 120-125.
13.	Porta AS, Lam N, Novotny P, et al. Low income as a determinant of exercise capacity in COPD. Chron Respir Dis, 2019, 16: 1479972318809491.
14.	Reijnders T, Schuler M, Jelusic D, et al. The impact of loneliness on outcomes of pulmonary rehabilitation in patients with COPD. COPD, 2018, 15(5): 446-453.
15.	Reijnders T, Schuler M, Wittmann M, et al. The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD. Respir Med, 2019, 146: 87-95.
16.	Puhan MA, Schünemann HJ, Buesching G, et al. COPD patients' ability to follow exercise influences short-term outcomes of rehabilitation. Eur Respir J, 2008, 31(2): 304-310.
17.	Selzler AM, Rodgers WM, Berry TR, et al. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabil Psychol, 2016, 61(4): 380-388.
18.	Wen Y, Liu L, Xun Z, et al. Effect of a rehabilitation garden on rehabilitation efficacy in elderly patients with chronic obstructive pulmonary disease. Pakistan J Zool, 2020, 52(6): 2393.
19.	Halding AG, Wahl A, Heggdal K. ‘Belonging’. ‘Patients' experiences of social relationships during pulmonary rehabilitation. Disabil Rehabil, 2010, 32(15): 1272-1280.
20.	Velasco R, Pirraglia PA, Casserly B, et al. Influence of body mass index on changes in disease-specific quality of life of veterans completing pulmonary rehabilitation. J Cardiopulm Rehabil Prev, 2010, 30(5): 334-339.
21.	Zoeckler N, Kenn K, Kuehl K, et al. Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients. J Psychosom Res, 2014, 76(2): 146-151.
22.	Hassan M, Mourad S, Wahab NHA, et al. Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc, 2016, 65(1): 63-69.
23.	Tunsupon P, Lal A, Abo Khamis M, et al. Comorbidities in patients with chronic obstructive pulmonary disease and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev, 2017, 37(4): 283-289.
24.	Huynh VC, Fuhr DP, Byers BW, et al. Influence of disease severity and exercise limitation on exercise training intensity and load and health benefits from pulmonary rehabilitation in patients with COPD: an exploratory study. J Cardiopulm Rehabil Prev, 2018, 38(5): 320-326.
25.	Bohn Júnior I, Costa CC, Souza RM, et al. Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype. J Bras Pneumol, 2020, 46(6): e20190309.
26.	Bamonti PM, Wiener CH, Weiskittle RE, et al. The impact of depression and exercise self-efficacy on benefits of pulmonary rehabilitation in veterans with COPD. Behav Med, 2023, 49(1): 72-82.
27.	廖星, 胡瑞学, 李博, 等. 混合方法研究评价工具的介绍—MMAT. 中国全科医学, 2021, 24(31): 4015-4020.
28.	Cohen S. Social relationships and health. Am Psychol, 2004, 59(8): 676-684.
29.	Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract, 2005, 6(2): 148-156.
30.	Arnold R, Ranchor AV, Koëter GH, et al. Changes in personal control as a predictor of quality of life after pulmonary rehabilitation. Patient Educ Couns, 2006, 61(1): 99-108.
31.	Troosters T, Casaburi R, Gosselink R, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2005, 172(1): 19-38.
32.	Theeke LA, Mallow J. Loneliness and quality of life in chronically Ill rural older adults: Findings from a pilot study. Am J Nurs, 2013, 113(9): 28-37.
33.	Lima MG, Barros MB, César CL, et al. Health-related behavior and quality of life among the elderly: a population-based study. Rev Saude Publica, 2011, 45(3): 485-493.
34.	Winer ES, Bryant J, Bartoszek G, et al. Mapping the relationship between anxiety, anhedonia, and depression. J Affect Disord, 2017, 221: 289-296.
35.	Franssen FM, Rochester CL. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter? Eur Respir Rev, 2014, 23(131): 131-141.
36.	Carreiro A, Santos J, Rodrigues F. Impact of comorbidities in pulmonary rehabilitation outcomes in patients with COPD. Rev Port Pneumol, 2013, 19(3): 106-113.
37.	Nguyen HQ, Fan VS, Herting J, et al. Patients with COPD with higher levels of anxiety are more physically active. Chest, 2013, 144(1): 145-151.
38.	Vagaggini B, Costa F, Antonelli S, et al. Clinical predictors of the efficacy of a pulmonary rehabilitation programme in patients with COPD. Respir Med, 2009, 103(8): 1224-1230.
39.	Ramachandran K, McCusker C, Connors M, et al. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD. Chron Respir Dis, 2008, 5(4): 205-209.
40.	Salepci B, Eren A, Cağlayan B, et al. The effect of body mass index on functional parameters and quality of life in COPD patients. Tuberk Toraks, 2007, 55(4): 342-349.

1. Venkatesan P. GOLD COPD report: 2023 update. Lancet Respir Med, 2023, 11(1): 18.
2. Vanfleteren LE, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013, 187(7): 728-735.
3. World Health Organization. The Top 10 Causes of Death. Available online: https://www.who.int/news-room //fact-sheets/detail/the-top-10-causes-of-death.
4. Hurst JR, Siddiqui MK, Singh B, et al. A systematic literature review of the humanistic burden of COPD. Int J Chron Obstruct Pulmon Dis, 2021, 16: 1303-1314.
5. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6. Puhan MA, Scharplatz M, Troosters T, et al. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality–a systematic review. Respir Res, 2005, 6(1): 1-12.
7. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med, 2009, 151(4): W65-W94.
8. Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated consolidated framework for implementation research based on user feedback. Implement Sci, 2022, 17(1): 75.
9. Buchi ST, Villiger B, Sensky T, et al. Psychosocial predictors of long-term success of in-patient pulmonary rehabilitation of patients with COPD. Eur Respir J, 1997, 10(6): 1272-1277.
10. Higashimoto Y, Yamagata T, Maeda K, et al. Influence of comorbidities on the efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int, 2016, 16(8): 934-941.
11. Bentsen SB, Wentzel-Larsen T, Henriksen AH, et al. Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation—An exploratory study. Patient Educ Couns, 2010, 81(1): 5-13.
12. 段玉香, 范晔, 陈妍, 等. 影响慢性阻塞性肺疾病患者呼吸康复训练疗效的因素. 中国现代医学杂志, 2016, 26(20): 120-125.
13. Porta AS, Lam N, Novotny P, et al. Low income as a determinant of exercise capacity in COPD. Chron Respir Dis, 2019, 16: 1479972318809491.
14. Reijnders T, Schuler M, Jelusic D, et al. The impact of loneliness on outcomes of pulmonary rehabilitation in patients with COPD. COPD, 2018, 15(5): 446-453.
15. Reijnders T, Schuler M, Wittmann M, et al. The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD. Respir Med, 2019, 146: 87-95.
16. Puhan MA, Schünemann HJ, Buesching G, et al. COPD patients' ability to follow exercise influences short-term outcomes of rehabilitation. Eur Respir J, 2008, 31(2): 304-310.
17. Selzler AM, Rodgers WM, Berry TR, et al. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabil Psychol, 2016, 61(4): 380-388.
18. Wen Y, Liu L, Xun Z, et al. Effect of a rehabilitation garden on rehabilitation efficacy in elderly patients with chronic obstructive pulmonary disease. Pakistan J Zool, 2020, 52(6): 2393.
19. Halding AG, Wahl A, Heggdal K. ‘Belonging’. ‘Patients' experiences of social relationships during pulmonary rehabilitation. Disabil Rehabil, 2010, 32(15): 1272-1280.
20. Velasco R, Pirraglia PA, Casserly B, et al. Influence of body mass index on changes in disease-specific quality of life of veterans completing pulmonary rehabilitation. J Cardiopulm Rehabil Prev, 2010, 30(5): 334-339.
21. Zoeckler N, Kenn K, Kuehl K, et al. Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients. J Psychosom Res, 2014, 76(2): 146-151.
22. Hassan M, Mourad S, Wahab NHA, et al. Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc, 2016, 65(1): 63-69.
23. Tunsupon P, Lal A, Abo Khamis M, et al. Comorbidities in patients with chronic obstructive pulmonary disease and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev, 2017, 37(4): 283-289.
24. Huynh VC, Fuhr DP, Byers BW, et al. Influence of disease severity and exercise limitation on exercise training intensity and load and health benefits from pulmonary rehabilitation in patients with COPD: an exploratory study. J Cardiopulm Rehabil Prev, 2018, 38(5): 320-326.
25. Bohn Júnior I, Costa CC, Souza RM, et al. Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype. J Bras Pneumol, 2020, 46(6): e20190309.
26. Bamonti PM, Wiener CH, Weiskittle RE, et al. The impact of depression and exercise self-efficacy on benefits of pulmonary rehabilitation in veterans with COPD. Behav Med, 2023, 49(1): 72-82.
27. 廖星, 胡瑞学, 李博, 等. 混合方法研究评价工具的介绍—MMAT. 中国全科医学, 2021, 24(31): 4015-4020.
28. Cohen S. Social relationships and health. Am Psychol, 2004, 59(8): 676-684.
29. Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract, 2005, 6(2): 148-156.
30. Arnold R, Ranchor AV, Koëter GH, et al. Changes in personal control as a predictor of quality of life after pulmonary rehabilitation. Patient Educ Couns, 2006, 61(1): 99-108.
31. Troosters T, Casaburi R, Gosselink R, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2005, 172(1): 19-38.
32. Theeke LA, Mallow J. Loneliness and quality of life in chronically Ill rural older adults: Findings from a pilot study. Am J Nurs, 2013, 113(9): 28-37.
33. Lima MG, Barros MB, César CL, et al. Health-related behavior and quality of life among the elderly: a population-based study. Rev Saude Publica, 2011, 45(3): 485-493.
34. Winer ES, Bryant J, Bartoszek G, et al. Mapping the relationship between anxiety, anhedonia, and depression. J Affect Disord, 2017, 221: 289-296.
35. Franssen FM, Rochester CL. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter? Eur Respir Rev, 2014, 23(131): 131-141.
36. Carreiro A, Santos J, Rodrigues F. Impact of comorbidities in pulmonary rehabilitation outcomes in patients with COPD. Rev Port Pneumol, 2013, 19(3): 106-113.
37. Nguyen HQ, Fan VS, Herting J, et al. Patients with COPD with higher levels of anxiety are more physically active. Chest, 2013, 144(1): 145-151.
38. Vagaggini B, Costa F, Antonelli S, et al. Clinical predictors of the efficacy of a pulmonary rehabilitation programme in patients with COPD. Respir Med, 2009, 103(8): 1224-1230.
39. Ramachandran K, McCusker C, Connors M, et al. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD. Chron Respir Dis, 2008, 5(4): 205-209.
40. Salepci B, Eren A, Cağlayan B, et al. The effect of body mass index on functional parameters and quality of life in COPD patients. Tuberk Toraks, 2007, 55(4): 342-349.

Chinese Journal of Respiratory and Critical Care Medicine

Factors influencing pulmonary rehabilitation outcomes in patients with COPD:a systematic review based on the new CFIR framework

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