健康教练技术对慢性阻塞性肺疾病患者影响的Meta分析

Meta-analysis of the influence of health coaching on patients with chronic obstructive pulmonary disease

目的系统评估健康教练技术对慢性阻塞性肺疾病(COPD)患者的影响。方法计算机检索中国知网、万方资源数据库、中国生物医学文献数据库、中文科技期刊数据库、PubMed、Embase、Cochrane Library、Web of Science中关于健康教练技术应用于COPD患者的随机对照试验,检索时限为建库至2022年1月10日。2名研究者对检索到的文献进行独立筛选、资料提取并通过Cochrane 5.1.0手册对纳入文献的质量进行评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入10项研究,包括1797例COPD患者。Meta分析结果显示,与常规护理组相比,健康教练技术组COPD患者干预后的再入院率降低(OR=0.42,95%CI:0.29~0.60,P<0.01),抑郁程度减轻(MD=-0.51,95%CI:-0.98~-0.04,P=0.03),疾病认知感提高(MD=3.83,95%CI:0.97~6.69,P=0.009),自我效能感提高(SMD=0.32,95%CI:0.09~0.55,P=0.006)。生活质量按研究工具不同进行亚组分析,结果显示各组间合并效应量差异有统计学意义(P<0.05);但在改善运动耐力、焦虑程度方面未显示明显优势。结论健康教练技术能够有效降低COPD患者的再入院率,可以对患者的抑郁情绪起到缓解作用,改善患者疾病认知,在自我效能和生活质量方面有提高作用,但在运动耐力、焦虑情绪改善方面缺乏一定的证据,需要开展深入研究进行验证。

Objective To systematically review the effects of health coaching on patients with chronic obstructive pulmonary disease(COPD).Methods CNKI,Wanfang Database,China Biology Medicine disc,VIP Database,PubMed,Embase,Cochrane Library,and Web of Science were searched for randomized controlled trials concerning the health coaching in COPD patients which were published up to January 10,2022.Two researchers independently screened the retrieved literature,extracted data,and evaluated the quality of the included literature according to the Cochrane 5.1.0 handbook.Meta-analysis was performed with RevMan 5.3.Results Finally,10 studies including 1797 COPD patients were included.Meta-analysis showed that compared with the routine care group,patients in the health coaching group experienced reduced readmission rates(0R=0.42,95%CI:0.29-0.60,P<0.01),alleviated depression(MD=-0.51,95%CI:-0.98--0.04,P=0.03),improved disease awareness(MD=3.83,95%CI:0.97-6.69,P=0.009),and enhanced self-efficacy(SMD=0.32,95%CI:0.09-0.55,P=0.006).The quality of life was analyzed in subgroups according to different research tools,and the results revealed that there was a statistically significant difference in the combined effect size among the subgroups(P<0.05);however,it showed no obvious advantage in improving exercise tolerance and reducing anxiety.Conclusions Health coaching can effectively reduce the readmission rate,alleviate the depression,improve the disease awareness,and enhance the self-efficacy and quality of life among COPD patients.However,there is a lack of evidence for its effect on exercise endurance and anxiety,and in-depth research is needed to verify it.