Application of a pulmonary rehabilitation exercise program based on IMB model in patients with moderate to severe chronic obstructive pulmonary disease

doi:10.3761/j.issn.0254-1769.2024.17.002

Abstract

Abstract:

Objective To explore the application and effect of a pulmonary rehabilitation exercise program in patients with moderate to severe COPD based on the Information-Motivation-Behavior Skill（IMB） Model. Methods The convenience sampling method was adopted to select patients with moderate to severe COPD admitted to the department of respiratory and critical care medicine in a tertiary A hospital in Yantai City from October 2021 to February 2022. They were randomly divided into an intervention group（32 cases） and a control group（31 cases）. The intervention group was treated with the pulmonary rehabilitation exercise program based on the IMB model on the basis of routine nursing，while the control group was treated with routine nursing. The degree of dyspnea，exercise endurance，quality of life，pulmonary rehabilitation exercise compliance，self-management ability and lung function were compared between the 2 groups before and 6 months after the intervention. Results After intervention，the degree of dyspnea，exercise endurance，quality of life，pulmonary rehabilitation exercise compliance and self-management ability were significantly different between the 2 groups（P<0.05）. There was no statistically significant difference in lung function between the 2 groups after intervention（P>0.05）. Conclusion The pulmonary rehabilitation program based on IMB model can effectively alleviate the symptoms of dyspnea in patients with moderate to severe COPD，improve exercise endurance，improve pulmonary rehabilitation exercise compliance and self-management ability，and improve the patients’ quality of life.

Key words: Information-Motivation-Behavior Skill Model, Pulmonary Disease, Chronic Obstructive, Pulmonary Rehabilitation, Self-Management, Nursing Care

摘要：

目的探讨基于信息-动机-行为技巧模型的肺康复方案在中重度慢性阻塞性肺疾病患者中的应用效果。方法采用便利抽样法，于2021年10月—2022年2月，选取烟台市某三级甲等医院呼吸与危重症医学科收治的中重度慢性阻塞性肺疾病患者为研究对象，随机分为试验组（n=32）和对照组（n=31）。试验组在常规护理的基础上实施6个月的基于信息-动机-行为技巧模型的肺康复，对照组实施常规护理措施，比较干预前及干预后两组呼吸困难程度、运动耐力、生活质量、肺康复依从性、自我管理水平及肺功能情况。结果干预后，试验组呼吸困难程度、运动耐力、生活质量、肺康复依从性及自我管理水平均优于对照组，差异有统计学意义（P<0.05），但两组肺功能的比较，差异无统计学意义（P>0.05）。结论基于信息-动机-行为技巧模型的肺康复可有效缓解中重度慢性阻塞性肺疾病患者呼吸困难症状，提高其运动耐力、肺康复的依从性及自我管理能力，改善生活质量。

关键词: 信息-动机-行为技巧模型, 肺疾病, 慢性阻塞性, 肺康复, 自我管理, 护理

ZHAO Lingyan, WANG Zhengyi, XU Shufen, DU Tiantian. Application of a pulmonary rehabilitation exercise program based on IMB model in patients with moderate to severe chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2024, 59(17): 2062-2069.

赵凌燕, 王正翊, 徐淑芬, 杜田田. 中重度慢性阻塞性肺疾病患者肺康复方案的实施效果研究[J]. 中华护理杂志, 2024, 59(17): 2062-2069.

Figures/Tables 7

Table 1 Pulmonary rehabilitation exercise plan for COPD patients

Table 2 Comparison of general data between the 2 groups

Table 3 Comparison of dyspnea and quality of life between 2 groups before and after intervention（scores，$\bar{x}\pm s$）

Table 4 Comparison of 6MWT between 2 groups before and after intervention（m，$\bar{x}\pm s$）

Table 5 Comparison of self-management levels between 2 groups before intervention（scores，$\bar{x}\pm s$）

Table 6 Comparison of self-management levels between 2 groups after intervention（scores，$\bar{x}\pm s$）

Table 7 Comparison of lung function indicators between 2 groups before and after intervention（$\bar{x}\pm s$）

References 28

[1]	Qian Y, Cai CT, Sun MQ, et al. Analyses of factors associated with acute exacerbations of chronic obstructive pulmonary disease:a review[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18:2707-2723.
[2]	Wang C, Xu JY, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China(the China Pulmonary Health[CPH]study):a national cross-sectional study[J]. Lancet, 2018, 391(10131):1706-1717.
[3]	Guo M, Yu C, Li ZN. The efficacy and safety of budesonide/glycopyrronium/formoterol in the treatment of COPD in the elderly[J]. Contrast Media Mol Imaging, 2022, 2022:8382295.
[4]	Global Initiative for Chronic Obstructive Lung Disease(GOLD). Global strategy for prevention,diagnosis and management of COPD: 2024 report[EB/OL]. (2023-11-30) [2024-03-06]. https://goldcopd.org/2024-gold-report/.
[5]	沈蓝君, 程云. 稳定期慢性阻塞性肺疾病患者肺康复依从性的研究进展[J]. 中华护理杂志, 2020, 55(5):710-715. DOI
	Shen LJ, Cheng Y. Research progress on pulmonary rehabilitation compliance in patients with stable COPD[J]. Chin J Nurs, 2020, 55(5):710-715.
[6]	Sami R, Salehi K, Hashemi M, et al. Barriers to adherence to home-based pulmonary rehabilitation among patients with chro-nic obstructive pulmonary disease in Iran:a descriptive qualitative study[J]. BMJ Open, 2023, 13(10):e073972.
[7]	黄秋玉, 刘华, 荣湘江, 等. 近10年国内外慢性呼吸系统疾病康复的可视化分析[J]. 中国康复理论与实践, 2022, 28(8):939-959. DOI
	Huang QY, Liu H, Rong XJ, et al. Rehabilitation of chronic respiratory diseases domestic and overseas in recent ten years:a visualization analysis[J]. Chin J Rehabil Theory Pract, 2022, 28(8):939-959.
[8]	Lee MH, Park YH. The effectiveness of the information-motiva-tion-behavioral skills model-based intervention on preventive behaviors against respiratory infection among community-dwelling older adults[J]. Patient Educ Couns, 2021, 104(8):2028-2036.
[9]	庄艳君, 宋润珞. 信息-动机-行为技巧模型在健康促进中的应用进展[J]. 职业与健康, 2021, 37(23):3298-3302.
	Zhuang YJ, Song RL. Advances in application of information-motivation-behavioral skills model in health promotion[J]. Occup Health, 2021, 37(23):3298-3302.
[10]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3):170-205.
	Chronic Obstructive Pulmonary Disease Group of Respiratory Medicine Branch of Chinese Medical Association, Chronic Obstructive Pulmonary Disease Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association. Guidelines for the diagnosis and management of chronic obstructive pulmonary disease(revised version 2021)[J]. Chin J Tuberc Respir Dis, 2021, 44(3):170-205.
[11]	张义静, 李娟, 孙丽, 等. 慢性阻塞性肺疾病患者早期简易肺康复方案的构建及应用[J]. 中华护理杂志, 2020, 55(5):690-695. DOI
	Zhang YJ, Li J, Sun L, et al. Construction of an early simple pulmonary rehabilitation programme for patients with COPD and its evaluation of effectiveness[J]. Chin J Nurs, 2020, 55(5):690-695. DOI
[12]	苗青, 韩艳波, 张金凤. 《ATS/ERS共识:肺康复要点与进展》中肺康复运动处方解读[J]. 实用心脑肺血管病杂志, 2017, 25(1):1-3.
	Miao Q, Han YB, Zhang JF. Interpretation for pulmonary reha-bilitation exercise prescription from ATS/ERS consensus on key point and progress of pulmonary rehabilitation[J]. Pract J Card Cereb Pneumal Vasc Dis, 2017, 25(1):1-3.
[13]	Fletcher CM, Elmes PC, Fairbairn AS, et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population[J]. Br Med J, 1959, 2(5147):257-266.
[14]	Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test[J]. Eur Respir J, 2009, 34(3):648-654. DOI PMID
[15]	Finch S, Laska IF, Abo-Leyah H, et al. Validation of the COPD assessment test(CAT) as an outcome measure in bronchiectasis[J]. Chest, 2020, 157(4):815-823.
[16]	Chan WLS, Pin TW. Reliability,validity and minimal detectable change of 2-minute walk test,6-minute walk test and 10-meter walk test in frail older adults with dementia[J]. Exp Gerontol, 2019, 115:9-18.
[17]	Bourbeau J, Bartlett SJ. Patient adherence in COPD[J]. Thorax, 2008, 63(9):831-838. DOI PMID
[18]	张彩虹, 何国平, 李继平, 等. 慢性阻塞性肺疾病患者自我管理量表的编制与考评[J]. 中国全科医学, 2011, 14(28):3219-3223.
	Zhang CH, He GP, Li JP, et al. Development and evaluation of Self-Management Scale for Chinese Patients with Chronic Obstructive Pulmonary Disease[J]. Chin Gen Pract, 2011, 14(28):3219-3223.
[19]	武亮, 郭琪, 胡菱, 等. 中国呼吸重症康复治疗技术专家共识[J]. 中国老年保健医学, 2018, 16(5):3-11.
	Wu L, Guo Q, Hu L, et al. Expert consensus on rehabilitation treatment of severe respiratory diseases in China[J]. Chin J Geriatr Care, 2018, 16(5):3-11.
[20]	宁锋. 动机性访谈对老年COPD患者肺功能、呼吸锻炼行为以及依从性的影响[J]. 中国实用医药, 2020, 15(16):178-181.
	Ning F. Effect of motivational interview on pulmonary function,respiratory exercise behavior and compliance of elderly COPD patients[J]. Chin Prac Med, 2020, 15(16):178-181.
[21]	刘彦彦, 李雅洁, 路寒冰, 等. 运动训练在慢性阻塞性肺疾病病人康复中的应用研究进展[J]. 护理研究, 2023, 37(11):1966-1972.
	Liu YY, Li YJ, Lu HB, et al. Research progress on application of exercise training in rehabilitation of patients with chronic obstructive pulmonary disease[J]. Chin Nurs Res, 2023, 37(11):1966-1972.
[22]	司树梅, 王银萍, 吴艳红. 基于信息-动机-行为技巧模型的运动康复干预在慢性阻塞性肺疾病患者中的应用效果[J]. 中国临床护理, 2018, 10(2):113-116. DOI
	Si SM, Wang YP, Wu YH. Influence of exercise rehabilitation intervention based on IMB skill model on quality of life in patients with COPD[J]. Chin Clin Nurs, 2018, 10(2):113-116. DOI
[23]	郎蔓, 李培君, 王婷, 等. 运动对慢性阻塞性肺疾病患者通气功能障碍的影响[J]. 中国老年学杂志, 2023, 43(1):205-211.
	Lang W, Li PJ, Wang T, et al. Effect of exercise on ventilation dysfunction in patients with chronic obstructive pulmonary disease[J]. Chin J Gerontol, 2023, 43(1):205-211.
[24]	中国肺康复护理联盟肺康复护理专家共识组. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志, 2020, 55(增刊):78-84.
	China Pulmonary Rehabilitation Nursing Alliance(CPRNA) Expert Group on Pulmonary Rehabiltation Nursing Consensus. Expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases[J]. Chin J Nurs, 2020, 55(suppl):78-84.
[25]	Cravo A, Attar D, Freeman D, et al. The importance of self-management in the context of personalized care in COPD[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17:231-243.
[26]	Benzo R, McEvoy C. Effect of health coaching delivered by a respiratory therapist or nurse on self-management abilities in severe COPD:analysis of a large randomized study[J]. Respir Care, 2019, 64(9):1065-1072.
[27]	Grosbois JM, Gephine S, Kyheng M, et al. Improving the wellbeing of caregivers of patients with COPD using a home-based pulmonary rehabilitation programme[J]. ERJ Open Res, 2022, 8(4):00255-02022.
[28]	Liu K, Yu XJ, Cui XF, et al. Effects of proprioceptive neuromuscular facilitation stretching combined with aerobic training on pulmonary function in COPD patients:a randomized controlled trial[J]. Int J Chron Obstruct Pulmon Dis, 2021, 16:969-977.