| Objective: The problems caused by chronic obstructive pulmonary disease(COPD)have seriously affected the quality of life of patients,increased the social economic burden and medical burden.Although pulmonary rehabilitation can effectively reduce the negative impact on COPD,but during the implementation process,there are still problems such as traffic,distance,lack of professional rehabilitation personnels and so forth.The participation and completion of pulmonary rehabilitation has not lived up to expectations.The above problems can be solved by telemedicine pulmonary rehabilitation in patients with COPD,so as to promote patients to participate in pulmonary rehabilitation and insist on pulmonary rehabilitation.At present,the implementation details of telemedicine intervention in COPD have not been described,and the effectiveness of telemedicine intervention is still unclear.In addition,previous studies lacked application of theoretical models,and rarely combined with behavioral intervention.Therefore,the purpose of this study is: 1.To summarize the implementation details of telemedicine in patients with COPD,and evaluate the effect of intervention by systematic review and Meta-analysis.2.Based on the results of systematic review and Meta-analysis,guided by the e Health Enhanced Chronic Care Model(eCCM)and combined with the strategy of behavioral intervention to construct a telemedicine pulmonary rehabilitation intervention program and evaluate its effect.Methods: This study is divided in two parts.1.By searching researches of recently ten years in Embase,Cochrane Library,Pub Med,CNKI,Wan Fang data,and VPCS.Retrieval time is up to July of 2018.For the researches that conform to PICOS standard,excel was used to extract data and Revman 5.3 was used for data analysis.2.According to some components of e CMM combined with behavioral intervention strategy to improve self-efficacy,to construct and implement the intervention program of telemedicine pulmonary rehabilitation.A total of 106 patients were randomly selected to the intervention group(telemedicine intervention)and control group(face-to-face).The outcomes were measured at 3 months and 6 months after the intervention.The primary outcome was the score of COPD assessment test(CAT).The secondary outcomes were the score of modified Medical Research Council scale(m MRC),Exercise self-regulatory efficacy scale(Ex-SRES)and St George’s Respiratory Questionnaire(SGRQ).Spss20.0 was used for data entry and analysis.Results: 1.A total number of 24 studies were meta-analyzed.Nurses were the main intervention providers,mobile phones were the most commonly used equipment,and the duration of the intervention varied.Quality of life in the group of the telemedicine intervention was better than that in the control group(MD =-4.93 [95% CI,-6.86 to-3.01],P < 0.001),(I2 = 86%,P < 0.001).The rates of hospitalization were lower than those in the control group(OR = 0.24 [95% CI,0.20 to 0.29],P < 0.001),(I2 = 25%,P = 0.14).2.There were not statistically significant differences in CAT(F1,3=7.78,P=0.001),Ex-SRES(F1,3=21.91,P<0.001)and m MRC(F1,3=29.64,P<0.001)between the the intervention group(telemedicine intervention)and control group(face-to-face)with the variation of time tendency.In the sixth month,no significant difference was found between the measured value and the preintervention value of SGRQ-symptom,SGRQ-activity,SGRQ-influence and SGRQ-total in the two groups(P = 0.27,P = 0.13,P = 0.09,P = 0.08,respectively).Ex-SRES had a significant effect on CAT(P =0.03),the partial regression coefficient of Ex-SRES to CAT was 0.81,and Exp(B)was 2.24.Conclusions: 1.The results of meta analysis showed that the implementation of telemedicine in patients with COPD has not yet been standardized in China.Results of review indicated that telemedicine in China was better than the control group,which could improve the quality of life and reduce the rates of hospitalization in patients with COPD,but this conclusion still needs to be further verified.2.The results of randomized controlled study showed that telemedicine intervention program was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy.There was no difference between the effect of telemedicine intervention and face-to-face intervention.After intervention,the self-efficacy and quality of life of patients were improved compared with preintervention,and the symptoms of dyspnea were alleviated. |
