| Objectives To evaluate the effect of the perioperative exercise program in patients with non-small cell lung cancer(NSCLC)and conduct a process evaluation of perioperative exercise intervention to explore the fidelity,mechanisms of impact and context.Methods1.Effectiveness evaluation of a perioperative exercise program in NSCLC patientsA non-contemporary experimental design was adopted.NSCLC patients from a hospital in Anhui Province were conveniently sampled from February 2022 to December 2022 and then grouped in the order of admission.The control group received perioperative routine care.The intervention group received perioperative exercise intervention on the basis of perioperative routine care,Outcomes included lung function,exercise tolerance,early postoperative complications,symptoms,exercise self-efficacy in lung cancer patients,the duration of chest drain retention,the length of hospital stay,and safety indicators.2.Process evaluation of perioperative exercise intervention in NSCLC patientsThe process evaluation was performed in parallel with the effectiveness evaluation,guided by the British Medical Research Council(MRC)process evaluation guidelines,including implementation,context and mechanism.The fidelity was quantitatively evaluated through exercise diaries.Quantitative interviews after intervention were performed to explore the mechanisms and context.Results1.Effectiveness evaluation of a perioperative exercise program in NSCLC patientsIn this study,166 NSCLC patients were included,88 in the control group and 78 in the intervention group.After the intervention,the intervention group PEF% Pred [48.00(39.55,56.55)],FEV1% Pred [54.00(46.00,64.20)],FVC%Pred [58.00(44.70,66.25)],which were all higher than the control group with PEF% Pred [42.50(34.00,50.75)],FEV1% Pred [50.00(43.00,61.00)],FVC%Pred [49.50(40.10,62.75)];The intervention group 6 MWD(419.02 ± 78.78)was higher than the control group 6 MWD(381.52 ± 82.89);in the intervention group,the severity of symptoms [19.50(12.75,30.00)],and Symptom Distress[2.00(0.00,5.25)] were lower than that in the control group [26.50(16.00,48.75)],[8.00(0.25,17.75)];Exercise self-efficacy in the intervention group [100.00(96.00,107.00)] was higher than that in the control group[98.00(92.00,102.00)];All the differences in the above outcomes were statistically significant(P <0.05).However,the incidence of early postoperative complications in the two groups were 18.18% and 20.51%,respectively,and the duration of chest drain retention was [3.00(2.00,4.00)] and [3.00(2.00,4.00)],and the hospital stay was [6.00(5.00,9.00)] and [6.00(5.00,7.85)],which were not statistically significant(P> 0.05).No exercise-related adverse events occurred throughout the perioperative period.2.Process evaluation of perioperative exercise intervention in NSCLC patientsIn preoperative period,the fidelity of each exercise was above 79%.In postoperative period,the fidelity of blowing balloons was 44.4%,the fidelity of other exercises was above 70%.20 patients in the intervention group were interviewed.The imechanisms of perioperative exercise intervention can be summarized into 4 themes :nurse-led perioperative exercise intervention,appropriate perioperative exercise program(exercise time,exercise type,exercise benefits),high exercise self-efficacy in NSCLC patients(high outcome expectation and improved exercise self-efficacy),caregivers support patients exercise.The facilitators of perioperative exercise were summarized into 6 themes: professional nurse leading exercise;perceived exercise benefits;high exercise self-efficacy,patient positive attitude;caregivers support exercise and pain also promotes exercise.The barriers to perioperative exercise are summarized into 4 themes: negative emotions;unapparent perceived exercise benefits,exercise inertia;and postoperative discomfort symptoms(pain and fatigue).Conclusion(1)Perioperative exercise program for NSCLC patients is effective and safe,which promotes the recovery of postoperative lung function and exercise tolerance in NSCLC patients,improves postoperative symptoms and exercise self-efficacy.(2)In the clinical application of the exercise program,we can adopt nurse-led perioperative exercise intervention,improve exercise self-efficacy and strengthen exercise support from caregivers,so as to make the perioperative exercise program for NSCLC patients play a better role.(3)There still be some facilitators and barriers in implementing the perioperative exercise program,which should be used as a theoretical basis in the future to develop targeted measures to improve patients’ exercise compliance. |
PDF Full Text Request