Healthcare professionals’ perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease: a critical interpretive synthesis

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Abstract
Purpose: To establish literature regarding healthcare professionals’ perceptions of pulmonary rehabilitation as a management strategy for patients with chronic obstructive pulmonary disease. Method: A critical interpretive synthesis was conducted; CINAHL, PsychINFO and MEDLINE were searched between 1988 and August 2019, using MeSH headings and key terms. Reference lists of accepted papers were also searched. Qualitative, quantitative and mixed methods studies, written in English, including healthcare professionals’ perceptions of pulmonary rehabilitation were included. The search yielded 133 papers which were assessed for eligibility; 20 met the inclusion criteria. Results: Two themes were identified, the first explored “Barriers to Pulmonary Rehabilitation” from a healthcare professional’s perspective. This incorporated a lack of knowledge, a lack of resources, practical barriers, patient barriers, and healthcare professional’s being unsure it is their role to refer. The second entitled “General Perceptions of Pulmonary Rehabilitation”, highlighted ways in which the programme could be improved, the perceived positives and negatives, facilitators to referral, and perceptions of patients referred. Conclusions: This is the first systematic review to encompass the perceptions of healthcare professionals with ability to refer and those who deliver pulmonary rehabilitation. Referral was low, highlighting potential influencing factors such as a lack of programme knowledge, pulmonary rehabilitation beliefs, and communication skills. Given inclusion of studies from multiple geographical locations, the findings provide implications for any healthcare system that develops and delivers pulmonary rehabilitation. With respect of a lack of referrals to the programme, further research should highlight healthcare professionals’ perceptions of the referral process, and the views of those in Secondary Care.

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