Barriers to access to pulmonary rehabilitation in developing countries: a systematic review

In low-income countries (LICs) and low-middle-income countries (LMICs),the burden of chronic respiratory diseases has increased due to a lack of prevention and the presence of barriers of entry to rehabilitation programs.The aim of this systematic review is to analyse the evidence on the implementation of pulmonary rehabilitation (PR) and on PR9s projects in LICs and LMICs. A systematic literature review was conducted.Four electronic database were searched for qualitative and quantitative studies that documented the existence of PR in LICs and LMICs.We report our findings following the Prisma guidelines.In addition,the grey literature was investigated including reports from local medical societies,articles not published in journals and local sites of LICs and LMICs included in the 2019-2020 Atlas World Bank list from January 2000 till December 2019.Articles not in English and not treating adult9s(<18 years old)were excluded.Data were extracted by one reviewer and synthesized in the form of tables. In total,112 publications were included in the review(of 21,694 records identified).In LICs,PR for HIV-infected patients and post-Tuberculosis were most frequent.Results indicated that 17/78 (13,26%) of LMICs offer PR.We found evidence of ongoing PR projects in 4 LICs and 13 LMICs. Findings suggest that the literature on global,economic and medical access to PR is spare in LICs and LMICs.Structured or non-structured rehabilitation programs for patients suffering from COPD,HIV and Tuberculosis are not frequently available in these countries.The most important barriers to access are the lack of know-how among professional healthcare givers and lack of funds.Challenges are ongoing to implement more PR.