Table 1. Characteristics of included studies (n=10).
| Study | Arnold et al.34 | Fischer et al.35 | Taylor et al.38 | Denn36 | Gysels and Higginson37 | Bulley et al.39 | Keating et al.5,11 | Moore et al.40 | Sohanpal et al.10,12,a12 | Guo and Bruce41 |
|---|---|---|---|---|---|---|---|---|---|---|
| Intervention | PR | PR | PR | PR | PR | PR | PR | PR | SM | PR |
| Country | UK | The Netherlands | UK | UK | UK | UK | Australia | UK | UK | Taiwan |
| Aim of the study/research questions | Explore experiences of patients who had been invited to attend PR to gain some insights into the aspects that may influence adherence | Explore factors (role of patients treatment beliefs, goals and practice barriers) predicting dropout in rehabilitation | Explore why participants who took part in a randomised controlled trial of a nurse-led intermediate care package (intervention: 4-week group-based PR programme) declined to take part in the intervention. | Explore patients' understanding and expectations 8 weeks before and after taking part in a PR programme | Understand how people respond to breathlessness: role of PR | How do individuals describe their views about attendance in PR following referral but before attendance? | What are the barriers to uptake of PR for people with COPD? What are the barriers to completion of PR for people with COPD? | Assess the obstacles to participation in PR among COPD patients in a community-based PR programme | Explore reasons for participation to a COPD-specific SM programme from patients with COPD and lay tutors. | Understand the experiences and thoughts attributed to PR attendance and to identify barriers and strategies to establish effective PR |
| The following was explored from the included studies for the synthesis | Experience of PR adherence | Factors predicting participation and dropout in PR | Reasons for non-participation in the research study of a PR programme | Expectations before and after taking part in a PR programme, which include factors affecting participation | Challenges of participation in PR | Exploration of views about participating in PR, in relation to previous experiences of COPD and its management | Exploration of possible reasons for individual experiences associated with non-attendance and non-completion | Exploring feasibility (the ability or capacity of patients to attend PR) and acceptability (the willingness to attend) among patients who completed or did not complete treatment and patients who were referred but did not complete treatment | Reasons for high and poor attendance in a COPD SM programme | The experiences and thoughts attributed to PR attendance |
| Was the study part of a mixed-methods study? | No | No | Yes | No | No | Scoping exercise for larger study | No | No | Yes | No |
| Sample | 20 | 12 | 39 | 5 | 5 | 10 | 18 | 12 | 16 | 25 |
| Type of data collection | Individual interviews | Individual interviews | Individual interviews, face to face and by telephone | Focus group | Observations, interviews and field notes | Individual interviews | Individual interviews, face to face and by telephone and observational memos | Interviews (individuals were allowed to have a supporter) | Individual interviews | Focus groups and individual interviews |
| Primary study underpinned by behavioural theory | No | No | No | No | No | No | No | No | No | No |
| Emergent themes and subthemes from primary studies on participation and/or completion | (1) Experience of adherence to PR: positive influence of the referring medical practitioner —self-help. (2) Experience of non-adherence to PR: —negative influence of the referring medical practitioner —social support and motivation. (3) Experience of adherence to PR. | (1) Reasons for referral to rehabilitation. (2) Beliefs about PR: —anticipated benefits of participation in the PR programme —concerns about participation in a PR programme —anticipated reasons for dropout. | (1) Travel to and location of pulmonary rehabilitation class {n=19/39} (48.7%). (2) Perception of benefit {n=19/39} (48.7%). (3) Competing commitments or demands {n=15/39} (38.5%). (4) Poor or negative understanding of the research study {n=12/39} (30.8%). (5) Past negative experience(s) {n=11} (28.2%). (6) Perception of health status {n=10/39} (25.6%). | (1) Stoicism (2) Fear (3) Comradeship (94) Empowerment (95) Concept of severity | (1) Pulmonary rehabilitation (2) Challenges (3) Benefits | (1) Desired benefits of attending PR. (2) Evaluating threat of exercise. (3) Attributing value to PR. | Did not attend major themes: (1) Getting there —lack of transport —poor mobility —cost. (2) No perceived benefit —will not make any difference —already exercising enough. (3) Being unwell —COPD —other medical. minor themes: (1) Competing demands (2) Age (3) Fatigue (4) Timing of programme. Did not complete major themes: (1) Being unwell —pain —other medical —exacerbation of COPD. (2) Getting there —lack of transport —poor mobility —cost. Minor themes: (1) Timing of programme (2) Fatigue (3) No perceived benefit (4) Lack of social support (5) Competing demands. | (1) Feasibility —co-morbidities —carer responsibility. (2) Acceptability —perception of PR for COPD —perception of exercise for COPD —presentation of information about PR —unwillingness to prioritise PR —stigma of smoking —suitability of group activity —view of professionals —recommendations of acquaintances —location of PR centre —role of experienced fellow patient —timing. | (1) Reasons for poor attendance —not ill enough —physical/psychological limitations —other obligations. (2) Reasons for high attendance —wanted to learn about SM —socialising —altruism. | (1) Building confidence. (2) Perceiving immediate tangible results. (3) Readiness and Access. |
| Modified CASP quality checklist score (out of 28) | 22 | 25 | 24 | 21 | 24 | 27 | 28 | 27 | 27 | 27 |
Abbreviations: CASP, critical appraisal skills programme; COPD, chronic obstructive pulmonary disease; PR, pulmonary rehabilitation; SM, self-management.
a
The study was included in the review as a grey report (2009). This grey report was published in 2012.