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How "Global" are Globally Oriented Pulmonary Rehabilitation Studies? Strategies to Promote Equitable Participation
Fanuel M Bickton1, Josan Sutherland, Patrick K Kalonde
1Author Affiliations: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi (Mr Bickton, Mr Kalonde, Ms Banda); Department of Rehabilitation Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi (Mr Bickton, Ms Namanja, Dr Chisati); Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom (Ms Sutherland, Prof Shannon); Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Mr Kalonde, Ms Banda); Department of Sport, Health and Exercise Science, The University of Hull, United Kingdom (Ms Namanja); Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa (Dr Lupton-Smith, Prof Gosselink, Prof Hanekom); Department of Rehabilitation, Wenjiang Area Hospital of Traditional Chinese Medicine, Chengdu, China (Mr Li); Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (Prof Allwood); Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh (Dr Habib); NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (Dr Habib); Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, University of Leuven, University Hospitals Leuven, Leuven, Belgium (Prof Gosselink); Health Data Science, University of Liverpool, Liverpool, United Kingdom (Dr Karumbi); Health Systems Research, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya (Dr Karumbi); World Health Organization, Geneva, Switzerland (Dr Rylance); Department of Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands (Prof Browne, Prof Heine); Utrecht Center for Global Challenges, Faculty of Law, Economics and Governance, Utrecht University, Utrecht, the Netherlands (Prof Browe); and Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa (Prof Heine).
Purpose:
To perform a systematic review of globally oriented pulmonary rehabilitation (PR) studies and describe low- and middle-income country (LMIC) participation including its enablers and barriers.
Review Methods:
Systematic search of PubMed was performed on November 18, 2024 using a search string "pulmonary rehabilitation" AND ("global" OR "international" OR "consensus" OR "standards" OR "guidelines" OR "recommendations" OR "statement" OR "position") followed by citation searching. All PR publications from January 1, 2010 onwards were included if they were globally oriented, reported original research data, and targeted people with chronic respiratory disease (with or without comorbidity). The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.
Summary:
Of the initial 1302 records screened in PubMed, 17 were assessed for eligibility by reviewing their full-text articles, which excluded 7 articles. Citation searching and snowballing yielded 5 more eligible articles, resulting in a total of 15 eligible articles included for analysis. Of these, 6 (40%) were explicitly global while the remainder were implicitly global. Study participants (n = 823) originated from 40 different countries, based on reported data or provided by correspondence. Of these, high-income countries contributed 748 participants (91%), followed by upper-middle-income countries with 59 participants (7%), lower-middle-income countries with 15 participants (12%), and one low-income country with 1 participant (<1%). Potential enablers of LMIC participation were using multiple participant recruitment and data collection methods, channels, platforms, and collecting data from participants using their native languages. Limited resources were identified as a potential barrier.
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