Patients' perspectives on pulmonary rehabilitation for pulmonary hypertension in high-altitude areas: a mixed-methods study.

Background: Chronic hypoxia at high altitudes worsens pulmonary hypertension (PH), leading to earlier symptom onset, more frequent exacerbations, and diminished quality of life. While pulmonary rehabilitation (PR) is known to enhance exercise capacity and ease breathlessness, implementing it in high-altitude settings presents a range of multifaceted challenges. Research capturing patients' firsthand experiences with PR in these settings is largely absent. This study explored how PH patients in high-altitude areas currently engage with PR, what barriers they encounter, and what support they need to inform better rehabilitation strategies. Methods: A mixed-methods design was utilized, combining a questionnaire survey of 206 PH patients with semi-structured interviews of 11 patients from a tertiary hospital in Xining, Qinghai Province. Quantitative data were analyzed using descriptive statistics, whereas qualitative data were analyzed using thematic analysis. Results: Quantitative findings showed that 53.88% of patients reported engaging in breathing exercises or physical training. Among the 111 participants who reported engaging in PR exercises, 90.09% perceived improvement in dyspnea and 87.39% perceived improvement in fatigue. The leading obstacles were high-altitude environmental constraints (54.85%), lack of professional guidance (41.75%), and technical complexity such as mastering breathing training techniques (35.92%). Patients most wanted telemedicine consultations (82.04%), disease education manuals (65.05%), and family nursing skills training (61.65%). Qualitative interviews uncovered three main themes, namely current PR practices and perceived symptom changes, barriers to PR implementation, and support needs related to PR, with eight subthemes. The qualitative findings were broadly consistent with and complementary to the quantitative results: although participants reported symptom improvement, multiple barriers impede consistent participation. Patients called for structured discharge planning, community-led rehabilitation, and remote follow-up options. Conclusion: Participants reported perceived improvements in dyspnea and fatigue after engaging in PR activities; however, PR implementation remained constrained by environmental constraints, insufficient professional guidance, and limited patient awareness. Patients expressed strong preferences for telemedicine, educational materials, community-based programs, and improved discharge planning. These findings highlight the need to strengthen standardized inpatient PR education and structured discharge planning to support continuity of rehabilitation from hospital to home and may inform the development and future evaluation of context-specific PR strategies for patients with PH living at high altitude.