基于移动健康平台的自我管理干预在慢性阻塞性肺疾病患者肺康复中的应用
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摘要
目的基于互联网+的背景下,构建一种行之有效的适用于慢性阻塞性肺疾病(COPD)患者的具有延续性、互动性和患者参与性的移动健康平台,并探讨该平台在COPD患者肺康复训练中的应用,以期延长肺康复的作用效果。方法 2017年3月至6月,在本院门诊治疗的COPD患者67例,分为对照组(n=33)和实验组(n=34)。对照组采用传统的自我管理干预方法,实验组在此基础上使用移动健康平台,进行动态、延续、针对性的肺康复指导和管理,并在平台中鼓励患者参与互动分享。干预前和干预1个月后分别采用第1秒用力呼气容积占预计值百分比(FEVI%)、COPD评估测试(CAT)、改良英国医学研究委员会问卷(mMRC)和自我管理量表评估两组肺功能、生活质量、呼吸困难程度和自我管理能力。结果干预前,两组FEV1%、CAT、mMRC和自我管理量表评分均无显著性差异(t <0.945,χ2=2.044, P> 0.05)。干预1个月后,实验组CAT评分显著降低(t=4.921, P <0.001),且明显低于对照组(t=3.508, P=0.001);mMRC评分改善(χ2=7.937, P <0.05),但与对照组比较无显著性差异(χ2=1.018, P> 0.05);自我管理量表评分显著升高(t=-5.650, P <0.001),且显著高于对照组(t=4.812, P <0.001)。结论本研究设计的延续性、互动性和患者参与性的移动健康平台可有效改善COPD患者的生活质量和自我管理能力,延长肺康复的作用效果。
Objective To design a mobile health platform with the features of continuity, interactivity and involvement, which is suitable for patients with chronic obstructive pulmonary disease(COPD); and to test the effect of this platform which is expected to prolong the effect of pulmonary rehabilitation for patients with COPD.Methods From March to June, 2016, 67 patients with COPD from department of respiration in our hospital were enrolled. They were divided into control group(n = 33) and intervention group(n = 34). The control group received the routine self-management intervention and the intervention group received the mobile health platform to carry out the dynamic, continuous and targeted pulmonary rehabilitation therapy and self-management intervention.They were assessed with forced expiratory volume in one second(FEV1%), COPD Assessment Test(CAT), modified Medical Research Council Dyspnea Scale(mMRC) and Self-management Scale.Results No statistical differences was found on all the indexes between two groups before intervention(t < 0.945, χ2=2.044, P > 0.05). One month after intervention, the score of CAT decreased(t = 4.921, P < 0.001), and was lower in the intervention group than in the control group(t = 3.508, P = 0.001); the score of mMRC improved(χ2=7.937, P < 0.05), but no difference was found between two groups(χ2=1.018, P > 0.05); the score of Self-management Scale significantly increased(t =-5.650, P < 0.001), and was significantly higher in the intervention group than in the control group(t = 4.812, P < 0.001).Conclusion The continuous, interactive and participatory mobile health platform designed in this study could effectively improve the quality of life and self-management ability of COPD patients, and prolong the effect of pulmonary rehabilitation.
Objective To design a mobile health platform with the features of continuity, interactivity and involvement, which is suitable for patients with chronic obstructive pulmonary disease(COPD); and to test the effect of this platform which is expected to prolong the effect of pulmonary rehabilitation for patients with COPD.Methods From March to June, 2016, 67 patients with COPD from department of respiration in our hospital were enrolled. They were divided into control group(n = 33) and intervention group(n = 34). The control group received the routine self-management intervention and the intervention group received the mobile health platform to carry out the dynamic, continuous and targeted pulmonary rehabilitation therapy and self-management intervention.They were assessed with forced expiratory volume in one second(FEV1%), COPD Assessment Test(CAT), modified Medical Research Council Dyspnea Scale(mMRC) and Self-management Scale.Results No statistical differences was found on all the indexes between two groups before intervention(t < 0.945, χ2=2.044, P > 0.05). One month after intervention, the score of CAT decreased(t = 4.921, P < 0.001), and was lower in the intervention group than in the control group(t = 3.508, P = 0.001); the score of mMRC improved(χ2=7.937, P < 0.05), but no difference was found between two groups(χ2=1.018, P > 0.05); the score of Self-management Scale significantly increased(t =-5.650, P < 0.001), and was significantly higher in the intervention group than in the control group(t = 4.812, P < 0.001).Conclusion The continuous, interactive and participatory mobile health platform designed in this study could effectively improve the quality of life and self-management ability of COPD patients, and prolong the effect of pulmonary rehabilitation.
引文
[1] Vogelmeier C F, Criner G J, Martinez F J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report:GOLD Executive Summary[J]. Arch Bronconeumol, 2017, 53(7):411-412.
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[3] Mammen M J, Sethi S. Macrolide therapy for the prevention of acute exacerbations in chronic obstructive pulmonary disease[J]. Pol Arch Med Wewn, 2012, 122(1-2):54-59.
[4] Committee G E. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary Disease(Revised 2015)[EB/OL]. http.//www. goldcopd.com.
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[7] Puhan M A, Gimeno-Santos E, Cates C J, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2016, 12:D5305.
[8] Cindy N L, Mackney J, Jenkins S, et al. Does exercise training change physical activity in people with COPD? A systematic review and metaanalysis[J]. Chron Respir Dis, 2012, 9(1):17-26.
[9] Nici L, Bontly T D, Zuwallack R, et al. Self-management in chronic obstructive pulmonary disease. Time for a paradigm shift?[J]. Ann Am Thorac Soc, 2014,11(1):101-107.
[10] Reyfman P A, Washko G R, Dransfield M T, et al. Defining impaired respiratory health. A paradigm shift for pulmonary medicine[J]. Am J Respir Crit Care Med, 2018,198(4):440-446.
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[12] Effing T W, Vercoulen J H, Bourbeau J, et al. Definition of a COPD self-management intervention:International Expert Group consensus[J]. Eur Respir J, 2016, 48(1):46-54.
[13] Cramm J M, Nieboer A P. The relationship between self-management abilities, quality of chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary disease in The Netherlands[J]. Int J Chron Obstruct Pulmon Dis, 2013, 8:209-214.
[14] Zwerink M, Brusse-Keizer M, van der Valk P D, et al. Self management for patients with chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2014(3):D2990.
[15]朱杰敏,叶本兰,陈美琴,等.慢性阻塞性肺疾病患者稳定期自我管理水平及其影响因素的研究[J].护理管理杂志, 2012, 12(5):308-310.
[16] Jones S E, Green S A, Clark A L, et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD:referrals, uptake and adherence[J]. Thorax, 2014, 69(2):181-182.
[17] Benzo R, Wetzstein M, Neuenfeldt P, et al. Implementation of physical activity programs after COPD hospitalizations:lessons from a randomized study[J]. Chron Respir Dis, 2015, 12(1):5-10.
[18]窦凤娇,张博论,余丽君.辅助慢性阻塞性肺疾病患者家庭运动的手机应用程序可行性探索[J].中国康复理论与实践, 2016, 22(4):482-487.
[19] Boyda E K. Pulmonary Rehabilitation:From Hospital to Home by Jerry A. O'Ryan, Donald G. Burns[J]. Am J Nursing, 1985, 85(3):341.
[20] Wong C K, Yu W C. Correlates of disease-specific knowledge in Chinese patients with COPD[J]. Int J Chron Obstruct Pulmon Dis, 2016,11:2221-2227.
[21]何霏,张雯,陈文华.健康教育在慢性阻塞性肺疾病肺康复中的应用进展[J].中国康复理论与实践, 2014, 20(11):1041-1046.
[22] Jones P W, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test[J]. Eur Respir J, 2009, 34(3):648-654.
[23] Fletcher C M, Elmes P C, Fairbairn A S, et al. Significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population[J]. Br Med J, 1959, 2(5147):257-266.
[24] Bestall J C, Paul E A, Garrod R, et al. Usefulness of the Medical Research Council(MRC)dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease[J]. Thorax, 1999, 54(7):581-586.
[25] Sundh J, Janson C, Lisspers K, et al. The Dyspnoea, Obstruction,Smoking, Exacerbation(DOSE)index is predictive of mortality in COPD[J]. Prim Care Respir J, 2012, 21(3):295-301.
[26] Natori H, Kawayama T, Suetomo M, et al. Evaluation of the Modified Medical Research Council Dyspnea Scale for predicting hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease[J]. Intern Med, 2016, 55(1):15-24.
[27]张彩虹.慢性阻塞性肺疾病患者自我管理水平及影响因素研究[D].长沙:中南大学护理学院, 2009.
[28] Kurmi O P, Davis K J, Hubert L K, et al. Patterns and management of chronic obstructive pulmonary disease in urban and rural China:a community-based survey of 25 000 adults across 10 regions[J]. BMJ Open Respir Res, 2018,5(1):e267.
[29]王军,周雪梅,杨旭,等.慢性阻塞性肺疾病患者随访三年肺功能的变化[J].中华内科杂志, 2016, 55(4):302-306.
[30]张智霞,张素,郭淑明,等.社区慢性阻塞性肺疾病患者自我管理能力调查研究[J].中国护理管理, 2015, 15(12):1414-1417.
[31]张彩虹,阳晓丽,郭洪花,等.自我管理项目对社区慢性阻塞性肺疾病患者焦虑抑郁及疲劳的影响[J].中国老年学杂志, 2017, 37(2):436-438.
[32]黄慧玲,罗艳华.老年慢性阻塞性肺疾病患者自我管理现状及影响因素分析[J].护理实践与研究, 2017, 14(15):36-38.
[33] Johnson-Warrington V, Rees K, Gelder C, et al. Can a supported selfmanagement program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial[J]. Int J Chron Obstruct Pulmon Dis, 2016, 11:1161-1169.
[34] Williams V, Price J, Hardinge M, et al. Using a mobile health application to support self-management in COPD:a qualitative study[J]. Br J Gen Pract, 2014, 64(624):e392-e400.
[35] Steventon A, Bardsley M, Billings J, et al. Effect of telehealth on use of secondary care and mortality:findings from the Whole System Demonstrator cluster randomised trial[J]. BMJ, 2012, 344:e3874.
[2] WHO. Chronic obstructive pulmonary disease(COPD)[EB/OL].(2018-11-30). http://www. who. int/zh/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)? fbclid=IwAR2Q8hu85YfnjW9mXhgQQVvEd4KouBBu1huZ4A0oRNIjAGcImfgDPC3K62Q.
[3] Mammen M J, Sethi S. Macrolide therapy for the prevention of acute exacerbations in chronic obstructive pulmonary disease[J]. Pol Arch Med Wewn, 2012, 122(1-2):54-59.
[4] Committee G E. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary Disease(Revised 2015)[EB/OL]. http.//www. goldcopd.com.
[5] Spruit M A, Singh S J, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement:key concepts and advances in pulmonary rehabilitation[J]. Am J Respir Crit Care Med,2013, 188(8):e13-e64.
[6] McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2015(2):D3793.
[7] Puhan M A, Gimeno-Santos E, Cates C J, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2016, 12:D5305.
[8] Cindy N L, Mackney J, Jenkins S, et al. Does exercise training change physical activity in people with COPD? A systematic review and metaanalysis[J]. Chron Respir Dis, 2012, 9(1):17-26.
[9] Nici L, Bontly T D, Zuwallack R, et al. Self-management in chronic obstructive pulmonary disease. Time for a paradigm shift?[J]. Ann Am Thorac Soc, 2014,11(1):101-107.
[10] Reyfman P A, Washko G R, Dransfield M T, et al. Defining impaired respiratory health. A paradigm shift for pulmonary medicine[J]. Am J Respir Crit Care Med, 2018,198(4):440-446.
[11] Egan C, Deering B M, Blake C, et al. Short term and long term effects of pulmonary rehabilitation on physical activity in COPD[J].Respir Med, 2012, 106(12):1671-1679.
[12] Effing T W, Vercoulen J H, Bourbeau J, et al. Definition of a COPD self-management intervention:International Expert Group consensus[J]. Eur Respir J, 2016, 48(1):46-54.
[13] Cramm J M, Nieboer A P. The relationship between self-management abilities, quality of chronic care delivery, and wellbeing among patients with chronic obstructive pulmonary disease in The Netherlands[J]. Int J Chron Obstruct Pulmon Dis, 2013, 8:209-214.
[14] Zwerink M, Brusse-Keizer M, van der Valk P D, et al. Self management for patients with chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev, 2014(3):D2990.
[15]朱杰敏,叶本兰,陈美琴,等.慢性阻塞性肺疾病患者稳定期自我管理水平及其影响因素的研究[J].护理管理杂志, 2012, 12(5):308-310.
[16] Jones S E, Green S A, Clark A L, et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD:referrals, uptake and adherence[J]. Thorax, 2014, 69(2):181-182.
[17] Benzo R, Wetzstein M, Neuenfeldt P, et al. Implementation of physical activity programs after COPD hospitalizations:lessons from a randomized study[J]. Chron Respir Dis, 2015, 12(1):5-10.
[18]窦凤娇,张博论,余丽君.辅助慢性阻塞性肺疾病患者家庭运动的手机应用程序可行性探索[J].中国康复理论与实践, 2016, 22(4):482-487.
[19] Boyda E K. Pulmonary Rehabilitation:From Hospital to Home by Jerry A. O'Ryan, Donald G. Burns[J]. Am J Nursing, 1985, 85(3):341.
[20] Wong C K, Yu W C. Correlates of disease-specific knowledge in Chinese patients with COPD[J]. Int J Chron Obstruct Pulmon Dis, 2016,11:2221-2227.
[21]何霏,张雯,陈文华.健康教育在慢性阻塞性肺疾病肺康复中的应用进展[J].中国康复理论与实践, 2014, 20(11):1041-1046.
[22] Jones P W, Harding G, Berry P, et al. Development and first validation of the COPD Assessment Test[J]. Eur Respir J, 2009, 34(3):648-654.
[23] Fletcher C M, Elmes P C, Fairbairn A S, et al. Significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population[J]. Br Med J, 1959, 2(5147):257-266.
[24] Bestall J C, Paul E A, Garrod R, et al. Usefulness of the Medical Research Council(MRC)dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease[J]. Thorax, 1999, 54(7):581-586.
[25] Sundh J, Janson C, Lisspers K, et al. The Dyspnoea, Obstruction,Smoking, Exacerbation(DOSE)index is predictive of mortality in COPD[J]. Prim Care Respir J, 2012, 21(3):295-301.
[26] Natori H, Kawayama T, Suetomo M, et al. Evaluation of the Modified Medical Research Council Dyspnea Scale for predicting hospitalization and exacerbation in Japanese patients with chronic obstructive pulmonary disease[J]. Intern Med, 2016, 55(1):15-24.
[27]张彩虹.慢性阻塞性肺疾病患者自我管理水平及影响因素研究[D].长沙:中南大学护理学院, 2009.
[28] Kurmi O P, Davis K J, Hubert L K, et al. Patterns and management of chronic obstructive pulmonary disease in urban and rural China:a community-based survey of 25 000 adults across 10 regions[J]. BMJ Open Respir Res, 2018,5(1):e267.
[29]王军,周雪梅,杨旭,等.慢性阻塞性肺疾病患者随访三年肺功能的变化[J].中华内科杂志, 2016, 55(4):302-306.
[30]张智霞,张素,郭淑明,等.社区慢性阻塞性肺疾病患者自我管理能力调查研究[J].中国护理管理, 2015, 15(12):1414-1417.
[31]张彩虹,阳晓丽,郭洪花,等.自我管理项目对社区慢性阻塞性肺疾病患者焦虑抑郁及疲劳的影响[J].中国老年学杂志, 2017, 37(2):436-438.
[32]黄慧玲,罗艳华.老年慢性阻塞性肺疾病患者自我管理现状及影响因素分析[J].护理实践与研究, 2017, 14(15):36-38.
[33] Johnson-Warrington V, Rees K, Gelder C, et al. Can a supported selfmanagement program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial[J]. Int J Chron Obstruct Pulmon Dis, 2016, 11:1161-1169.
[34] Williams V, Price J, Hardinge M, et al. Using a mobile health application to support self-management in COPD:a qualitative study[J]. Br J Gen Pract, 2014, 64(624):e392-e400.
[35] Steventon A, Bardsley M, Billings J, et al. Effect of telehealth on use of secondary care and mortality:findings from the Whole System Demonstrator cluster randomised trial[J]. BMJ, 2012, 344:e3874.