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

doi:10.3969/j.issn.1006-9771.2019.06.021

摘要/Abstract

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。

关键词: 慢性阻塞性肺疾病, 移动健康平台, 自我管理, 肺康复

Abstract: 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.

Key words: chronic obstructive pulmonary disease, mobile health platform, self-management, pulmonary rehabilitation

中图分类号:

R562.2

师晨曦, 王佳妮, 肖倩, 杨经玉, 贾燕瑞, 逯勇. 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[J]. 《中国康复理论与实践》, 2019, 25(6): 734-739.

SHI Chen-xi, WANG Jia-ni, XIAO Qian, YANG Jing-yu, JIA Yan-rui, LU Yong. Application of a Self-management Mobile Platform in Rehabilitation of Chronic Obstructive Pulmonary Disease[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(6): 734-739.

参考文献

1 VogelmeierC F, CrinerG J, MartinezF 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.
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=IwAR2Q8hu85 YfnjW9mXhgQQVvEd4KouBBu1huZ4A0oRNIjAGcImfgDPC3K 62Q.
3 MammenM J, SethiS. 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 CommitteeG E. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary Disease (Revised2015) [EB/OL]. http.//www. goldcopd.com.
5 SpruitM A, SinghS J, GarveyC, 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 McCarthyB, CaseyD, DevaneD, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease [J]. Cochrane Database Syst Rev, 2015(2): D3793.
7 PuhanM A, Gimeno-SantosE, CatesC J, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease [J]. Cochrane Database Syst Rev, 2016, 12: D5305.
8 CindyN L, MackneyJ, JenkinsS, et al. Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis [J]. Chron Respir Dis, 2012, 9(1): 17-26.
9 NiciL, BontlyT D, ZuwallackR, 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 ReyfmanP A, WashkoG R, DransfieldM 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 EganC, DeeringB M, BlakeC, 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 EffingT W, VercoulenJ H, BourbeauJ, et al. Definition of a COPD self-management intervention: International Expert Group consensus [J]. Eur Respir J, 2016, 48(1): 46-54.
13 CrammJ M, NieboerA 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 ZwerinkM, Brusse-KeizerM, van der ValkP 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 JonesS E, GreenS A, ClarkA L, et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence [J]. Thorax, 2014, 69(2): 181-182.
17 BenzoR, WetzsteinM, NeuenfeldtP, 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 BoydaE K. Pulmonary Rehabilitation: From Hospital to Home by Jerry A. O'Ryan, Donald G. Burns [J]. Am J Nursing, 1985, 85(3): 341.
20 WongC K, YuW 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 JonesP W, HardingG, BerryP, et al. Development and first validation of the COPD Assessment Test [J]. Eur Respir J, 2009, 34(3): 648-654.
23 FletcherC M, ElmesP C, FairbairnA 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 BestallJ C, PaulE A, GarrodR, 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 SundhJ, JansonC, LisspersK, 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 NatoriH, KawayamaT, SuetomoM, 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 KurmiO P, DavisK J, HubertL 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-WarringtonV, ReesK, GelderC, et al. Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial [J]. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1161-1169.
34 WilliamsV, PriceJ, HardingeM, 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 SteventonA, BardsleyM, BillingsJ, 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.

[1]	唐流泉, 彭兴云. 血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效[J]. 《中国康复理论与实践》, 2023, 29(7): 761-769.
[2]	彭娟,王洁萍,黄炜,樊必双,虞记华,曾今,黄丽衡,安丽娟,胥方元. 阈值负荷吸气肌训练对慢性阻塞性肺疾病患者呼吸功能、运动功能及生活质量影响的Meta分析[J]. 《中国康复理论与实践》, 2022, 28(9): 1022-1031.
[3]	张博超,杨朝,郭立泉,陈静,熊大曦. 基于机器学习的慢性阻塞性肺疾病急性加重预测模型的研究[J]. 《中国康复理论与实践》, 2022, 28(6): 678-683.
[4]	张妙媛,何英,李晓霞,彭敏,张蕾,刘姝颖,孔瑛. 脊髓损伤清洁间歇导尿患者自我管理现状及影响因素[J]. 《中国康复理论与实践》, 2022, 28(6): 716-724.
[5]	蔡倩,张溪,荆纯祥,蔡书宾,郭明凯,李际强. 弹性抗阻运动对慢性阻塞性肺疾病康复疗效的Meta分析[J]. 《中国康复理论与实践》, 2021, 27(8): 913-922.
[6]	王丹,李瑾,高民,张明,陈猛,张一帆,夏露露,陈伟. 基于WHO-FICs心肺运动试验在肺癌患者中应用的Scoping综述[J]. 《中国康复理论与实践》, 2021, 27(8): 923-935.
[7]	曾斌,刘亚康,王龙平,张鸣生. 慢性阻塞性肺疾病患者通气有效性与运动后心脏功能的关系[J]. 《中国康复理论与实践》, 2021, 27(7): 812-818.
[8]	杨肇宇,李培君,李健,刘晓丹,吴卫兵. 运动对慢性阻塞性肺疾病系统性炎症和骨骼肌功能障碍干预效果的系统综述[J]. 《中国康复理论与实践》, 2021, 27(12): 1443-1449.
[9]	王洁萍,彭娟,樊必双,滕悦,胥方元. 水中肺康复对慢性阻塞性肺疾病稳定期患者肺功能的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1329-1333.
[10]	陈雅琪, 蒋玉宇, 周春香, 许光清, 蒋为. 以同伴教育为核心的社区肺康复实施策略的质性研究[J]. 《中国康复理论与实践》, 2019, 25(4): 487-492.
[11]	刘建华, 董继革, 黄宝靓. 心肺康复对脑卒中患者运动功能恢复的效果[J]. 《中国康复理论与实践》, 2019, 25(11): 1342-1347.
[12]	王丹, 刘伟, 李仲铭, 钟莲梅. 慢性阻塞性肺疾病性周围神经病的神经电生理特点[J]. 《中国康复理论与实践》, 2018, 24(7): 846-849.
[13]	金静, 张彩云, 张志刚, 申希平, 何金杰, 郭德姣. 不同量表对慢性阻塞性肺疾病患者跌倒的应用价值[J]. 《中国康复理论与实践》, 2018, 24(7): 850-853.
[14]	刘景新, 吴卫兵, 刘晓丹, 胡军, 严隽陶. 神经肌肉电刺激对慢性阻塞性肺疾病患者骨骼肌的康复研究进展[J]. 《中国康复理论与实践》, 2018, 24(4): 410-415.
[15]	田家伟, 蔡丽婷, 侯昕珩. 呼吸训练器在稳定期慢性阻塞性肺疾病患者肺康复中的应用现状[J]. 《中国康复理论与实践》, 2018, 24(4): 416-421.