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

doi:10.16460/j.issn1008-9969.2024.05.044

摘要/Abstract

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

吴林梅, 梁志金, 刘瑞杰, 钟静静, 邱予骅. 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[J]. 护理学报, 2024, 31(5): 44-49.

WU Lin-mei, LIANG Zhi-jin, LIU Rui-jie, ZHONG Jing-jing, QIU Yu-hua. Barriers to and facilitators of exercise rehabilitation in patients with COPD: a CFIR-based systematic review[J]. Journal of Nursing, 2024, 31(5): 44-49.

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