Construction And Applicability Evaluation Of An Evidence-based Perioperative Exercise Intervention Program For Patients With Non-small Cell Lung Cancer

Objectives（1）To construct an evidence-based perioperative exercise program for patients with non-small cell lung cancer to provide a theoretical basis for clinical perioperative exercise in patients with lung cancer.（2）Application to explore its feasibility,acceptability and effectiveness.Methods The research was divided into two phase:Phase one: The development process was composed of the following four steps:qualitative research,meta-synthesis,summary of evidence-based resources and expert consultation.Through qualitative interviews to understand the status of the implementation of perioperative exercise in patients with non-small cell lung cancer especially existing problems and exercise promotion,as well as their experience and suggestions by clinical experts,conducting semi-structured interviews with clinical medical staff.Systematically retrieved qualitative studies regarding experiences of exercise training among lung cancer to explore the cognition,attitude and opinion of patients with lung cancer.Searched the evidence-based resources about perioperative exercise improving the health outcome of patients with non-small cell lung cancer,assessing methodological quality and evidence level,then summarize the best evidence.The first draft of the exercise program based on the results of qualitative research,meta-synthesis and summary of evidence,which was refined and improved the implementation details by clinical expert consultations to develop the perioperative exercise program for patients with non-small cell lung cancer.Phase two: Pilot study used convenience sampling to select 40 patients with non-small cell lung cancer who met the inclusion and exclusion criteria in a tertiary first-class hospital in Anhui Province,dividing two groups according to the time order of admission.We provided routine perioperative care in the control group.While in addtion to routine care,the perioperative exercise program for patients with non-small cell lung cancer was used in the intervention group,the content included balloon blowing,abdominal breathing,stairs climbing,resistance exercise,cough training and other during the day of admission to the day of discharge.After the intervention,the patients were interviewed with two questions to evalute the feasibility and acceptability of the exercise program.Effectiveness indicators included six-minute walk distance and exercise self-efficacy in lung cancer patients.IBM SPSS 24.0software was used for descriptive statistics,and two independent-samples t test,paired-samples t test and rank sum test were used to analyze the effect of perioperative exercise intervention on patients with non-small cell lung cancer.Results Phase one: 3 main themes were extracted through in-depth interviews with 11 clinical medical staff from four hospitals in Anhui Province: the adjustment strategy of medical staff to exercise guidance,the practical difficulties of exercise for non-small cell lung cancer patients,standardized exercise program requirements.A meta-synthesis of lung cancer patients’ experiences of exercise training included 11 studies.7 new categories were generated,and 3 synthesized results were obtained:exercise significantly improves patients’ physical and mental health;individualized exercise needs are necessary;barrier factors leads to reduced patient compliance.The evidence-based resource summary system retrieved relevant evidence.Totally 22 studies were included,including 1 evidence summary,3 guidelines,1 expert consensus,14 systematic reviews and 3 randomized controlled trials.Finally 22 pieces of best evidence involving 7 dimensions were summarized,namely,necessity of perioperative exercise,population suitable for performing perioperative exercise,pre-exercise health evaluation,preoperative exercise program,postoperative exercise program,precautions and effectiveness evaluation.Combined with qualitative research,meta-synthesis and summary of evidence to construct the program,which was adjusted in 5 places and added in 6 places,finally the perioperative exercise intervention program for non-small cell lung cancer patients was formed.Phase two: A sum of 40 patients were allocated into either intervention group or control group in which there were no significant baseline differences in general information,six-minute walk distance and exercise self-efficacy（P>0.05）.After the intervention,the completion rate and the compliance of the patients with the postoperative exercise program were 100% and 70%,respectively.18 patients agreed with the content of the exercise program.After the intervention,the six-minute walk distance and exercise self-efficacy in the intervention group were significantly higher than those in the control group（P<0.01）.Conclusion（1）The program including overall exercise requirements,preoperative exercise program,postoperative exercise program and precautions,with a total of 26 perioperative exercise intervention was developed by qualitative research,meta-synthesis,summary of evidence-based resources and expert consultation.（2）The program,worthing worthy of clinical application,has certain scientificity,rationality,reliability,feasibility,acceptability and validity.