Authors' objectives: There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies.

Authors' results and conclusions: In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients’ point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (n = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services. The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these factors, especially those identified by patients as limiting their access. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access. The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. Thus, the majority of access challenges identified by patients would not be addressed by the identified interventions. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access.

Authors' methods: We conducted a mapping review of UK review-level evidence published 2017–21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers. Time limitations constrained the consideration of study quality and precluded the inclusion of additional searching methods such as citation searching and contacting key authors. This may have implications for the completeness of the evidence base identified. For inclusion, a review must have reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention that aims to increase the commencement, continuation or completion of rehabilitation. We included systematic reviews that reported factors identified from a UK context published between 2017 and 2021. Reviews that focused on the clinical effectiveness of rehabilitation or compare modes of rehabilitation (e.g. physical activity vs. other), or location of rehabilitation (e.g. community vs. hospital) were considered to be outside the scope of this review. We conducted a single search process to retrieve both systematic reviews of intervention effectiveness (i.e. quantitative) and of factors impacting upon engagement (i.e. qualitative). The search privileged the main subject headings for the two focal topics of interest: Cardiac Rehabilitation [MESH] and Lung Diseases/rehabilitation* OR Pulmonary Disease, Chronic Obstructive/rehabilitation. The main subject headings were combined with free-text terms and synonyms for engagement, uptake, completion, barriers and facilitators. The searches on MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health (CINAHL) used filters to retrieve references to review publications. Further web-based searches were also conducted to facilitate the inclusion of recent initiatives that are not yet reported in the systematic review literature. Sources of recent initiatives included the databases of the King’s Fund and Health Services Management Centre, alongside brief internet-based searches. Study selection was undertaken independently by two reviewers. Following piloting of a test set each record was screened by two of the three reviewers. In cases of uncertainty each was cross referred to the third reviewer. Data synthesised from quantitative studies were determined by the reporting characteristics of the included reviews. Interventions have been tabulated alongside the summary results of included reviews. Data relating to PROGRESS-Plus variables were also extracted where reported. The review includes published and formally evaluated projects and programmes together with recent initiatives awaiting evaluation.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR135449

Year Published: 2023

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/KLWR9463

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/KLWR9463

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk