Healthcare providers’ attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study

Abstract

ObjectivesTo assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral.DesignA cross-sectional online survey consisting of nine multiple-choice questions.SettingsSaudi Arabia.Participants980 HCPs including nurses, respiratory therapists (RT) and physiotherapists.Primary outcome measuresHCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia.ResultsOverall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was ‘mobility affected by breathlessness’ (64%), while the ‘availability of PR centres’ (61%), the ‘lack of trained HCPs’ (52%) and the ‘lack of authority to refer patients’ (44%) were the most common barriers to referral.ConclusionPR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers.

Perception and clinical practice regarding mucus clearance devices with chronic obstructive pulmonary disease: a cross-sectional study of healthcare providers in Saudi Arabia

“…This is an indicator that clinical practice is missing the best practice strategy by not recommending MCDs 15 16 26. However, it must be remembered that domestic clinical practice guidelines cannot be generalised to fit all clinical centres and hospitals in Saudi Arabia as there are other aspects to be considered, such as maturity of COPD care in the kingdom as well as the cost and availability of the devices 13 16 27…”

“…This may be attributed to the growing clinical evidence regarding MCD effectiveness in COPD management 8. In Saudi Arabia, there are a limited number of advanced COPD clinics that provide comprehensive COPD management, including MCD training 16 27 30. The use of MCDs, like any other airway clearance technique, needs training for both patients and HCPs 31.…”

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“…We used a modified version of a survey that was previously designed, created, and validated by Aldhahir et al [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The survey consisted of ten closed multiple-choice questions with free text spaces for extra comments.…”

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“…In recent years, understanding of the pathogenetic mechanisms involved in COPD has greatly increased [ 130 ]. Indeed, the awareness of the wide range of inflammatory patterns that can be observed in this disabling condition led to the identification of more personalized rehabilitation and pharmacological approaches [ 131 , 132 , 133 , 134 , 135 ], with a potential role for biologically targeted therapies. The inflammatory pattern in COPD is extremely variegated.…”