心力衰竭患者运动康复促进和障碍因素的系统评价

Enablers and barriers of exercise rehabilitation in patients with heart failure:a systematic review

目的系统评价心力衰患者运动康复的促进和障碍因素,为患者实施针对性运动康复提供参考。方法系统检索PubMed、Embase、Medline、Web of Science、中国生物医学文献数据库、万方数据、维普网、中国知网等中英文数据库中关于心力衰竭患者运动康复促进和障碍因素的质性研究、量性研究和混合性研究,时限为建库至2023年1月。根据文献纳入与排除标准进行文献筛选,由2名研究者独立进行数据提取和质量评价。以实施性研究综合框架的5个维度为基础,分析心力衰竭患者运动康复的促进和障碍因素。结果共纳入19篇文献,2576例心力衰竭患者。通过对纳入文献研究结果的提取,总结出心力衰竭患者运动康复15条促进因素、20条障碍因素,归纳为干预方案特征层面、外部因素层面、内部因素层面、个体特征层面和实施过程层面5个类别。结论心力衰竭患者实施性研究综合框架5个维度中运动康复行为的促进和阻碍因素的确定,可为心力衰竭患者制定运动康复策略提供参考。建议采取多方面的策略,解决多个领域的因素,以促进心力衰竭患者开展运动康复。

Objective To identify enablers and barriers related to exercise rehabilitation among patients with heart failure,so as to provide a reference for conducting targeted exercise rehabilitation for this population.Methods Studies related to enablers and bar-riers of exercise rehabilitation in patients with heart failure were retrieved from the electronic databases of PubMed,Embase,Medline,Web of Science,ProQuest,SinoMed,Wanfang,VIP and CNKI from the establishment of the database to January 2023.According to the inclusion and exclusion criteria,relevant studies were screened;two researchers independently extracted data and evaluated the quality of included literature.Based on the Consolidated Framework for Implementation Research,the enablers and barriers were analyzed.Results A total of 19 studies were included with 2576 participants.By extracting the results from the inclu-ded literature,totally 15 enablers and 20 barriers of exercise rehabilitation among patients with heart failure were summarized,which were classified into five dimensions:intervention characteristic,outer setting,inner setting,individual characteristic and process.Conclusion Identification of the enablers and barriers to exercise rehabilitation among patients with heart failure according to the Consolidated Framework for Implementation Research,can provide evidence for developing exercise rehabilitation strategies for this population.Multiple strategies which address factors across several domains are recommended to facilitate exercise rehabilitation among patients with heart failure.