Abstract
Pulmonary rehabilitation is a strongly recommended and effective treatment for people with chronic lung disease. However, access to pulmonary rehabilitation is poor. Globally, pulmonary rehabilitation is accessed by less than 3% of people with chronic lung disease. Barriers to referral, uptake and completion of pulmonary rehabilitation are well documented and linked with organizational, practitioner and patient-related factors. Enhancing the knowledge of health care professionals, family carers, and people with chronic lung disease about the program and its benefits produces modest increases in referral and uptake rates, but evidence of the sustainability of such approaches is limited. Additionally, initiatives focusing on addressing organizational barriers to access, such as expanding services and implementing alternative models to the conventional center-based setting, are not yet widely used in clinical practice. The COVID-19 pandemic has highlighted the urgent need for health care systems to deliver pulmonary rehabilitation programs remotely, safely, and efficiently. This paper will discuss the pressing need to address the issue of the low accessibility of pulmonary rehabilitation. It will also highlight the distinctive challenges to pulmonary rehabilitation delivery in rural and remote regions, as well as low-income countries.
Highlights
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The official American Thoracic Society (ATS)/European Respiratory society (ERS) statement defined pulmonary rehabilitation as ‘a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors’ [2]
In people with chronic obstructive pulmonary disease (COPD), strong evidence confirms that pulmonary rehabilitation optimizes muscle function, improves exercise capacity, reduces dyspnea and enhances health-related quality of life [4]
Summary
Decades of research has demonstrated consistent barriers to access to pulmonary rehabilitation. The official ATS/ERS statement of 2015 highlighted important barriers to pulmonary rehabilitation including insufficient funding, limited resources and lack of knowledge and skill of healthcare professionals and patients regarding the benefits of pulmonary rehabilitation [11]. In 2017, a systematic review using the theoretical domains framework studied barriers to referral, uptake and participation in 48 scientific reports [12]. 70% of included articles identified environmental barriers, 38% reported barriers related to lack of knowledge about pulmonary rehabilitation and 31% reported barriers related to beliefs about consequences [12]. Common barriers to pulmonary rehabilitation across the domains of referral, uptake and completion are shown, along with examples of interventions that aim to address the critical determinants of pulmonary rehabilitation participation
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