以质量求发展,以服务铸品牌

护理学报 ›› 2024, Vol. 31 ›› Issue (5): 44-49.doi: 10.16460/j.issn1008-9969.2024.05.044

• 循证护理 • 上一篇    下一篇

COPD患者运动康复促进和阻碍因素的系统评价-基于CFIR多层次理论

吴林梅1, 梁志金2, 刘瑞杰1, 钟静静1, 邱予骅2   

  1. 1.广西中药大学 护理学院,广西 南宁 530001;
    2.广西中医药大学附属瑞康医院,广西 南宁 530001
  • 收稿日期:2023-12-18 出版日期:2024-03-10 发布日期:2024-04-08
  • 通讯作者: 梁志金(1965-),女,广西南宁人,本科学历,主任护师。E-mail:lzj2188116@163.com
  • 作者简介:吴林梅(1998-),女,山西晋城人,本科学历,硕士研究生在读,护士。
  • 基金资助:
    广西壮族自治区中医药管理局自筹经费科研课题(GZZC2020119)

Barriers to and facilitators of exercise rehabilitation in patients with COPD: a CFIR-based systematic review

WU Lin-mei1, LIANG Zhi-jin2, LIU Rui-jie1, ZHONG Jing-jing1, QIU Yu-hua2   

  1. 1. School of Nursing, Guangxi University of Chinese Medicine, Nanning 530001, China;
    2. Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530001, China
  • Received:2023-12-18 Online:2024-03-10 Published:2024-04-08

摘要: 目的 系统评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者参与运动康复的促进和阻碍因素,为运动方案的制定提供参考。方法 系统检索8个中英文数据库中有关COPD患者运动康复促进及阻碍因素的相关研究,检索时限为建库至2023年8月。根据实施性研究综合框架(Consolidated Framework for Implementation Research, CFIR)多层次理论,对文献中提出影响COPD患者运动康复的促进和阻碍因素进行识别和编码,并依据CFIR的5个维度进行归类和整理。结果 最终纳入31项研究,涉及2 458例COPD患者、4名家庭成员、48名康复师、3名全科医生和9名利益相关者。通过对纳入文献研究结果提取,总结出COPD患者康复运动的19条促进因素和21条阻碍因素,归纳为干预特征、外部因素、内部因素、个体特征和实施过程5个类别,其中个体特征层面影响因素最多,且更关注COPD患者的个性特征,较少关注领导者和促进者等角色在相关研究中的作用。结论 CFIR的5个维度中运动康复行为促进和障碍因素的确定,可为COPD患者制定运动康复策略提供参考;但有些亚类别如外部政策、外部协助、领导者和促进者的因素较少关注,建议在今后的研究中进一步挖掘上述因素在促进COPD患者运动康复中的潜力,同时在全面评估患者情况的基础上,采取多方面的策略,解决多个领域的因素,提升COPD患者运动康复的依从性。

关键词: 慢性阻塞性肺疾病, 运动康复, 促进因素, 阻碍因素, 系统评价, 实施性研究综合框架

Abstract: Objective To identify the barriers to and facilitators of exercise rehabilitation in patients with chronic obstructive pulmonary disease (COPD), and to provide reference for the formulation of exercise programs. Methods We conducted systematical research in 8 Chinese and English databases for qualitative, quantitative, and mixed studies on facilitators to and barriers of exercise rehabilitation in patients with COPD, and the retrieval period spanned from the inception of the databases to August 2023. The facilitating and hindering factors influencing exercise rehabilitation in patients with COPD were identified and coded according to the multilevel theory of Consolidated Framework for Implementation Research (CFIR), and the influencing factors were categorized based on the 5 dimensions of CFIR. Results Totally 31 studies were included, involving 2,458 COPD patients, 4 family members, 48 rehabilitators, 3 general practitioners, and 9 stakeholders. A total of 19 facilitators and 21 barriers were summarized, including 5 categories of intervention characteristics, external factors, internal factors, individual characteristics and implementation process. Most influencing factors were found in the category of individual characteristics, but less attention was paid to the importance of roles such as leaders and facilitators in exercise rehabilitation of COPD patients. Conclusion The identification of facilitators of and barriers to exercise rehabilitation based on the 5 dimensions of CFIR can inform the development of exercise rehabilitation strategies for patients with COPD; however, some subcategories, such as external policies, external assistance, leaders, and facilitators, have received less attention. It is recommended that the potential of these subcategories in facilitating exercise rehabilitation for patients with COPD should be further explored, while adopting multifaceted strategies based on a comprehensive assessment of the patient to address factors in multiple domains to enhance adherence to exercise rehabilitation in patients with COPD.

Key words: chronic obstructive pulmonary disease, exercise rehabilitation, barrier, facilitator, systematic review, Consolidated Framework for Implementation Research

中图分类号: 

  • R473.56
[1] Singh D, Agusti A, Anzueto A, et al.Global strategy for the diagnosis, management,and prevention of chronic obstructive lung disease: the GOLD science committee report 2019[J]. Eur Respir J, 2019,53(5):1900164. DOI: 10.1183/13993003.00164-2019.
[2] Xiao L, Duan H, Li P, et al.A systematic review and Meta-analysis of Liuzijue in stable patients with chronic obstructive pulmonary disease[J]. BMC Complement Med Ther, 2020,20(1):308. DOI: 10.1186/s12906-020-03104-1.
[3] 林思婷, 罗梦娜, 汪丹, 等. 健身气功对COPD患者康复效果的系统评价再评价[J]. 护理学报, 2019, 26(21):41-45. DOI:10.16460/j.issn1008-9969.2019.21.041.
[4] 王凤燕, 张冬莹, 梁振宇, 等. 面向全科医生的《慢性阻塞性肺疾病诊治指南(2021年修订版)》解读[J]. 中国全科医学, 2021, 24(29):3660-3663, 3677. DOI:10.12114/j.issn.1007-9572.2021.01.304.
[5] Heerema-Poelman A, Stuive I, Wempe JB.Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?[J]. J Cardiopulm Rehabil Prev, 2013,33(6):419-426. DOI:10.1097/HCR.0b013e3182a5274a.
[6] 宋玛丽, 岑慧红, 罗俏玲, 等. 社区COPD患者家庭肺康复现状调查及影响因素分析[J]. 中华现代护理杂志, 2016, 22(11):1486-1493. DOI:10.3760/cma.j.issn.16742907.2016.11.002.
[7] Pierobon A, Sini Bottelli E, Ranzini L, et al.COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation[J].Int J Chron Obstruct Pulmon Dis, 2017(12):2059-2067. DOI: 10.2147/COPD.S133586.
[8] Witcher CS, McGannon KR, Hernandez P, et al. A qualitative exploration of exercise among pulmonary rehabilitation participants: insight from multiple sources of social influence[J]. Respir Care, 2015,60(11):1624-1634.DOI:10.4187/respcare.04120.
[9] 陈奕, 钮美娥, 钱红英, 等. 慢性阻塞性肺疾病患者实施居家力量训练感受的质性研究[J].中国实用护理杂志, 2016, 32(5):321-325.DOI:10.3760/cma.j.issn.1672-7088.2016.05.001.
[10] Østergaard EB, Sritharan SS, Kristiansen AD, et al.Barriers and motivational factors towards physical activity in daily life living with COPD - an interview based pilot study[J]. Eur Clin Respir J, 2018,5(1):1484654.DOI:10.1080/20018525.2018.1484654.
[11] 张兰萍,吕森森,何文俊, 等. 实施性研究综合框架(CFIR)更新版的解析和应用[J]. 护理学报, 2023, 30(11):47-52. DOI:10.16460/j.issn1008-9969.2023.11.047.
[12] 系统综述或Meta分析研究方法的撰写要点[J].系统综述或Meta分析研究方法的撰写要点[J]. 中华护理杂志, 2023, 58(17): 2094.
[13] 廖星, 胡瑞学, 李博, 等. 混合方法研究评价工具的介绍--MMAT[J]. 中国全科医学, 2021, 24(31):4015-4020. DOI:10.12114/j.issn.1007-9572.2021.00.215.
[14] O'Shea SD, Taylor NF, Paratz JD. Factors affecting adherence to progressive resistance exercise for persons with COPD[J]. J Cardiopulm Rehabil Prev, 2007,27(3):166-176.DOI: 10.1097/01.HCR.0000270686.78763.c8.
[15] Lewis R,Cramp F.Facilitators and barriers to exercise maintenance in chronic obstructive pulmonary disease: patient views[J]. Physiotherapy Ireland, 2010, 31(2):19-24. DOI:10.3233/PPR-2010-31205.
[16] Hellem E, Bruusgaard KA, Bergland A.Exercise maintenance: COPD patients' perception and perspectives on elements of success in sustaining long-term exercise[J]. Physiother Theory Pract, 2012,28(3):206-220.DOI:10.3109/09593985.2011.587502.
[17] Tang CY, Taylor NF, Blackstock FC.Patients admitted with an acute exacerbation of chronic obstructive pulmonary disease had positive experiences exercising from the beginning of their hospital stay: a qualitative analysis[J]. Chron Respir Dis, 2013, 10(4):197-205.DOI:10.1177/1479972313504941.
[18] Inal-Ince D, Savci S, Saglm M, et al.Predictors of physical inactivity in elderly patients with chronic obstructive pulmonary disease[J]. International Journal of Gerontology, 2014, 8(4):193-196. DOI: 10.1016/j.ijge.2013.01.015.
[19] Desveaux L, Rolfe D, Beauchamp M, et al.Participant experiences of a community-based maintenance program post-pulmonary rehabilitation[J]. Chron Respir Dis, 2014,11(1):23-30. DOI: 10.1177/1479972313516880.
[20] Stewart KF, Meis JJ, Van De Bool C, et al. Maintenance of a physically active lifestyle after pulmonary rehabilitation in patients with COPD: a qualitative study toward motivational factors[J]. J Am Med Dir Assoc, 2014, 15(9):655-664. DOI: 10.1016/j.jamda.2014.05.003.
[21] Thorpe O, Kumar S, Johnston K.Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study[J]. Int J Chron Obstruct Pulmon DiS, 2014(9):115-128.DOI:10.2147/COPD.S54457.
[22] Hoaas H, Andreassen HK, Lien LA, et al.Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study[J]. BMC Med Inform Decis Mak, 2016(16):26. DOI: 10.1186/s12911-016-0264-9.
[23] 刘泓, 杜毓锋, 刘学军.老年COPD稳定期患者家庭肺康复自我体验的质性研究[J]. 护理学杂志, 2016, 31(5): 76-80. DOI: 10.3870/j.issn.1001-4152.2016.05.076.
[24] Kosteli MC, Heneghan NR, Roskell C, et al.Barriers and enablers of physical activity engagement for patients with COPD in primary care[J].Int J Chron Obstruct Pulmon Dis, 2017(12):1019-1031. DOI:10.2147/COPD.S119806.
[25] 李丹, 朱素翠.COPD患者拒绝肺康复治疗影响因素的质性研究[J]. 护理学杂志, 2017, 32(13): 6-9. DOI: 10.3870/j.issn.1001-4152.2017.13.006.
[26] 刘霞, 苌静, 邹凤宇, 等. 稳定期COPD患者运动自主性现状及影响因素分析[J]. 中华现代护理杂志, 2018, 24(29):3548-3551. DOI:10.3760/cma.j.issn.1674-2907.2018.29.017.
[27] 张义静, 李娟, 唐瑶, 等. 稳定期COPD患者家庭运动训练现状调查与分析[J]. 齐鲁护理杂志, 2018, 24(3): 53-56. DOI: 103969/j.issn,1006-7256.2018.03.021.
[28] Damhus CS, Emme C, Hansen H.Barriers and enablers of COPD telerehabilitation - a frontline staff perspective[J].Int J Chron Obstruct Pulmon Dis,2018(13):2473-2482. DOI: 10.2147/COPD.S167501.
[29] 金莲锋, 陆海晴. 慢性阻塞性肺疾病患者力量训练依从性的质性研究[J]. 现代消化及介入诊疗,2019(S1):55-56.
[30] 金梦妮, 张蓓蕾, 陈达奇, 等. 急性加重期慢性阻塞性肺疾病患者肺康复运动锻炼不依从原因的质性研究[J]. 中国实用护理杂志, 2020, 36(34):2660-2664. DOI:10.3760/cma.j.cn211501-20200211-00333.
[31] 于春妮, 魏军, 樊晓军, 等. 稳定期慢性阻塞性肺疾病患者家庭运动训练现状调查及其影响因素的Logistic回归分析[J]. 现代生物医学进展, 2020, 20(18): 3443-3447. DOI: 1673-6273(2020)18-3443-05.
[32] Meshe OF, Bungay H, Claydon LS.Participants' experiences of the benefits, barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease[J]. Health Soc Care Community, 2020,28(3):969-978. DOI: 10.1111/hsc.12929.
[33] 洪涵涵, 蔡爱旎, 宋茂, 等. COPD病人肺康复运动训练的质性研究[J]. 循证护理, 2021, 7(4):514-518. DOI: 10.12102/J.ISSEN.2095-8668.2021.04.015.
[34] Cerini T, Kunz R, Dalla Lana K, et al.Evaluation of the implementation of a home-based exercise training program for people with COPD: a mixed-methods study[J]. Front Rehabil Sci,2021(2):743588.DOI:10.3389/fresc.2021.743588.
[35] Sritharan SS, Østergaard EB, Callesen J, et al.Barriers toward physical activity in COPD: a quantitative cross-sectional, questionnaire-based study. COPD[J]. 2021,18(3):272-280. DOI: 10.1080/15412555.2021.1922371.
[36] 王晶晶, 白晨晓, 张泽懿, 等. 老年慢性阻塞性肺疾病患者锻炼行为感知现状及影响因素分析[J].中华护理杂志, 2022, 57(1):36-42.DOI:10.3761/j.issn.0254-1769.2022.01.005.
[37] 梁发存, 刘梦如, 尹艳茹, 等. 慢性阻塞性肺疾病患者运动恐惧的调查研究[J]. 中华护理杂志, 2023, 58(6):721-726. DOI: 10.3761/j.issn.0254-1769.2023.06.012.
[38] Ricke E, Bakker EW.Development and validation of a multivariable exercise adherence prediction model for patients with COPD: a prospective cohort study[J]. Int J Chron Obstruct Pulmon Dis, 2023(18):385-398. DOI:10.2147/COPD.S401023.
[39] Chen FT, Hopman RJ,Huang CJ,et al.The effect of exercise training on brain structure and function in older adults: a systematic review based on evidence from randomized control trials[J]. J Clin Med, 2020,9(4):914. DOI:10.3390/jcm9040914.
[40] 李俊, 王黎铭, 余荣环, 等. 上海市徐汇区全科医生慢性阻塞性肺疾病及肺康复相关知识的认知调查[J]. 上海医药, 2021, 42(6):7-9, 34. DOI:1006-1533(2021)06-0007-03.
[41] Bateman RM, Sharpe MD, Jagger JE, et al.36th international symposium on intensive care and emergency medicine: brussels, belgium. 15-18 March 2016[J]. Crit Care, 2016, 20(Suppl 2): 94. DOI: 10.1186/s13054-016-1208-6.
[42] 余雅琪, 余艮珍, 熊晓, 等. 行为改变轮理论概述及临床护理应用进展[J]. 护理学报, 2023,30(4):38-43. DOI:10.16460/j.issn1008-9969.2023.04.038.
[1] 伍丽华, 吴心雨, 赖湘瑜, 邓宝贵, 黄泽青, 赵耀, 廖源, 沈彩萍, 李瑜. 人工关节置换术后患者深静脉血栓风险预测模型的系统评价[J]. 护理学报, 2025, 32(3): 12-16.
[2] 李嘉琪, 莫文娟, 王一棋, 王洁, 李梦楠, 刘兴, 冯佳. 基于COSMIN方法对慢性疼痛患者恐动症坦帕评分表的系统评价[J]. 护理学报, 2025, 32(2): 56-62.
[3] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[4] 余璐, 黄晓沁, 刘琳, 袁嘉敏, 邬青. 心力衰竭患者30天非计划性再入院风险预测模型的系统评价[J]. 护理学报, 2024, 31(8): 43-48.
[5] 周越, 张杰, 潘宇帆, 戴雨, 孙羽健, 肖益, 余雨枫. 机械通气患者衰弱风险预测模型的系统评价[J]. 护理学报, 2024, 31(6): 56-61.
[6] 王丽云, 张明慧, 张新月, 沙凯辉. 产后压力性尿失禁风险预测模型的系统评价[J]. 护理学报, 2024, 31(3): 57-62.
[7] 杨丽娜, 黄蓉, 姚梅琦, 王竹青, 徐怡婷, 谢佩敏. 产后母乳喂养行为中断风险预测模型的系统评价[J]. 护理学报, 2024, 31(23): 59-65.
[8] 魏小雪, 欧阳丰, 刘杨, 杜庆锋. 超重和肥胖患者体质量控制促进和障碍因素的系统评价:基于实施性研究综合框架[J]. 护理学报, 2024, 31(23): 66-72.
[9] 章明阳, 刘京辉, 金雁, 徐文琪, 李斌飞, 黄珊, 杜李百合, 侯亚甜, 李小寒. 围手术期低体温风险预测模型的系统评价[J]. 护理学报, 2024, 31(22): 54-60.
[10] 张亦然, 王康美, 朱盛财, 朱璐, 黄沂. 中文版高血压患者自我管理评估工具的系统评价:基于COSMIN指南[J]. 护理学报, 2024, 31(19): 52-57.
[11] 王丹宁, 纪星, 闫伟红, 张丹, 迟俊涛. 冠心病PCI术后患者居家运动康复依从性现状及影响因素的混合研究[J]. 护理学报, 2024, 31(16): 6-11.
[12] 张义静, 李国宏, 赵雨婷. 基于慢性阻塞性肺疾病患者需求的远程肺康复管理方案的构建[J]. 护理学报, 2024, 31(15): 62-67.
[13] . 轻度认知障碍向阿尔兹海默病进展风险预测模型的系统评价[J]. 护理学报, 2024, 31(12): 47-53.
[14] 张新芳, 谢庆, 张燕, 吴敏, 陈寄梅, 陈晓霞, 王玲. 行左心室辅助装置安装的终末期心力衰竭患者运动康复的最佳证据总结[J]. 护理学报, 2024, 31(10): 43-47.
[15] 孙小卫, 王燕, 闵春燕, 段菲, 肖江琴. 322例老年COPD患者生活空间现状及影响因素分析[J]. 护理学报, 2023, 30(8): 1-6.
Viewed
Full text


Abstract

Cited

  Shared   
No Suggested Reading articles found!