How “Global” are Globally Oriented Pulmonary Rehabilitation Studies? Strategies to Promote Equitable Participation From Low- and Middle-Income Countries A SYSTEMATIC REVIEW

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.