基于跨理论模型的居家肺康复方案在慢性阻塞性肺疾病患者中的可行性和有效性研究

Feasibility and Effectiveness of Transtheoretical Model Guided Home-based Pulmonary Rehabilitation Program in Patients with Chronic Obstructive Pulmonary Disease

目的探讨基于跨理论模型(TTM)的居家肺康复方案在慢性阻塞性肺疾病(COPD)患者中的可行性和有效性。方法选取2016年8月—2019年2月山东省职业卫生与职业病防治研究院呼吸内科收治的COPD患者116例,采用抛硬币法分为对照组和试验组,每组58例。对照组患者接受居家肺康复方案,试验组患者接受基于TTM的居家肺康复方案;两组患者均持续干预24周。比较两组患者居家运动依从性及干预前后运动行为、肺功能指标〔包括第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)〕、6分钟步行距离(6MWD)、慢性阻塞性肺疾病评估测试(CAT)评分,并比较两组患者干预期间不良事件发生情况。结果(1)试验组患者居家运动总体依从率、完全依从率高于对照组(P<0.05)。(2)两组患者干预前运动行为比较,差异无统计学意义(P>0.05);试验组患者干预后运动行为优于对照组(P<0.05)。(3)两组患者干预前FEV1%、FEV1/FVC、6MWD、CAT评分及干预后FEV1%、FEV1/FVC比较,差异无统计学意义(P>0.05);试验组患者干预后6MWD长于对照组,CAT评分低于对照组(P<0.05)。(4)两组患者干预期间均未发生严重不良事件。结论基于TTM的居家肺康复方案在COPD患者中安全可行,其可有效提高患者运动依从性及运动耐力,改善患者生活质量,但并未明显改善患者肺功能。

Objective To investigate the feasibility and effectiveness of Transtheoretical Model(TTM) guided home-based pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease(COPD). Methods From August 2016 to February 2019,a total of 116 patients with COPD were selected in the Department of Respiratory Medicine,Shandong Academy of Occupational Health and Occupational Diseases,and they were divided into control group and experiment group by coin tossing method,with 58 cases in each group. Patients in control group received home-based pulmonary rehabilitation program,while patients in experiment group received TTM guided home-based pulmonary rehabilitation program;patients in the two groups were continuously intervened for 24 weeks. Exercise behavior,exercise compliance,index of pulmonary function(including FEV1% and FEV1/FVC),6-minute walking distance(6 MWD)and CAT score were compared between the two groups before and after intervention,moreover incidence of adverse events was observed during intervention. Results (1)Overall exercise compliance rate and complete exercise compliance rate in experiment group were statistically significantly higher than those in control group(P<0.05).(2)There was no statistically significant difference in exercise behavior between the two groups before intervention(P>0.05),while exercise behavior in experiment group was statistically significantly better than that in control group after intervention(P<0.05).(3)No statistically significant difference of FEV1%,FEV1/FVC,6 MWD or CAT score was found between the two groups before intervention,nor was FEV1% or FEV1/FVC after intervention(P>0.05);6 MWD in experiment group was statistically significantly longer than that in control group after intervention,while CAT score in experiment group was statistically significantly lower than that in control group(P<0.05).(4)No one in the two groups occurred any serious adverse events during intervention. Conclusion TTM guided homebased pulmonary rehabilitation program is safe and effective in patients with COPD,which can effectively improve the exercise compliance,exercise tolerance and quality of life,but it can not effectively improve the pulmonary function.