Evidence map›Paper›PMID 40611129›Full record

SynthesisBMC pulmonary medicine2025

Barriers and facilitators to pulmonary rehabilitation in COPD: a mixed-methods systematic review.

Hua Qin, Ping Jia, Qilin Yan, Xi Li, Yan Zhang, Hong Jiang, Hongmei Yang, Linzhang Li

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC pulmonary medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Hua Qin *Pulmonary and Critical Care Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Ping Jia *School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China.
Qilin YanDepartment of Hospital Infection Prevention and Control, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Xi LiDepartment of Rehabilitation Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Yan ZhangSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China.
Hong JiangPulmonary and Critical Care Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Hongmei YangDepartment of Hospital Infection Prevention and Control, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China.
Linzhang LiPulmonary and Critical Care Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China. linzhang_li@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis mixed-methods systematic review examines determinants influencing engagement in pulmonary rehabilitation (PR) among patients with chronic obstructive pulmonary disease (COPD) and synthesizes evidence to guide intervention strategies.

methodsFollowing PRISMA guidelines, 29 studies (2006–2023) from eight databases were analyzed using the Joanna Briggs Institute (JBI) convergent integrated approach for data integration. The PRECEDE model categorized barriers into predisposing (psychological, health literacy), reinforcing (interpersonal dynamics), and enabling (structural) domains. Methodological quality was assessed with the Mixed Methods Appraisal Tool.

resultsPsychological barriers, such as anxiety and low health literacy, significantly diminished motivation for rehabilitation. Interpersonal challenges revealed insufficient healthcare provider competencies-such as inadequate clinical guidance and communication gaps-which undermined therapeutic alliances and patient adherence. Family support enhanced participation but risked dependency without structured education. Structural inequities, particularly urban-rural resource disparities and financial constraints, systematically excluded vulnerable populations. Persistent smoking emerged as a critical behavioral barrier, reflecting both physiological and self-care challenges. Facilitators included trust in healthcare providers, accessible urban rehabilitation resources, and personalized care plans.

conclusionPR participation is governed by interacting psychological, interpersonal and structural factors that shift with care context. A six-domain implementation schema (mental-health screening, flexible access, tele-rehabilitation plus caregiver toolkits, clinician up-skilling, peer reinforcement and targeted economic support) provides actionable leverage to lessen barriers and strengthen facilitators. Empathic, two-way communication among professionals, patients and families remains pivotal to converting exercise prescriptions into durable self-management. Future research should test the effectiveness and cost-utility of this integrated package across settings and further refine digital tools for tailoring programme intensity and follow-up.

Indexed as

Health Services AccessibilityPulmonary Disease, Chronic ObstructiveHealth LiteracyHumansMotivationPatient ComplianceSelf CareBarriersCOPDFacilitatorsMixed-method systematic reviewPulmonary rehabilitation

Identifiers

PMID40611129
PMCPMC12224770

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.