Rate of, and barriers and enablers to, pulmonary rehabilitation referral in COPD: A systematic scoping review

Respir Med. 2018 Apr:137:103-114. doi: 10.1016/j.rmed.2018.02.021. Epub 2018 Feb 28.


Background: Despite pulmonary rehabilitation (PR) being an evidence-based treatment recommended for people with chronic obstructive pulmonary disease (COPD), referral to PR seems to be low. Collating the evidence on referral rates and perceived barriers and enablers may help provide knowledge needed to increase referral.

Objectives: The purpose of this scoping review was to determine 1) the rate of referral of patients with COPD to PR by healthcare professionals (HCPs) and 2) the barriers and enablers to referral perceived by HCPs.

Methods: The JBI scoping review manual was used. Ovid Medline, CINAHL, EMBASE, and ProQuest Dissertations and Theses were searched from inception until July 28, 2017. 245 non-duplicate articles were screened. Included articles reported referral rates and/or HCP perceived barriers and/or enablers to PR referral.

Results: Forty-two studies were included. Twenty-eight observational studies reported referral rates ranging from 0% to 85%. Seven studies looking at the effects of different interventions to improve COPD care reported a range of 2%-56% referral pre-intervention, and 8%-71% post-intervention. Nine studies reported HCP perceived barriers to referral. The two most common barriers were low knowledge of what PR is and its benefits and low knowledge of the referral process. Six studies reported HCP perceived enablers to referral. The most common enabler was training/experience in PR.

Conclusion: The rate of referral to PR is suboptimal, but there are commonly reported barriers and enablers that may help with the creation of actionable changes. HCPs need more knowledge of PR and the benefits it provides.

Keywords: Chronic obstructive pulmonary disease; Exacerbation; Pulmonary rehabilitation; Referral.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Disease Progression
  • Evidence-Based Medicine / standards
  • Female
  • Health Behavior / physiology
  • Health Personnel / psychology*
  • Humans
  • Male
  • Middle Aged
  • Observational Studies as Topic
  • Perception
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Referral and Consultation / statistics & numerical data*