| Objectives1.To understand the experience and cognitive needs of pulmonary rehabilitation training in elderly patients with chronic obstructive pulmonary disease.2.To explore the application effect of self-service pulmonary rehabilitation intervention program based on patient needs and empowerment theory.Methods1.Cognitive needs for pulmonary rehabilitation training in older adults with COPDThe objective sampling method was used to select 13 patients with chronic obstructive pulmonary disease who met the inclusion criteria from December 2019 to May 2020 in Zhengzhou Navigation East Road Community Health Service Center and Nanyang New Village Health Service Center for semi-structured interviews.The Colaizzi sevenstep analysis method was used to analyze the interview data to understand the influencing factors and rehabilitation needs of rehabilitation training in elderly patients with chronic obstructive pulmonary disease.2.Intervention study of self-service pulmonary rehabilitation on elderly patients with chronic obstructive pulmonary disease at homeThe quasi-experiment study was adopted to construct a self-service pulmonary rehabilitation program based on the qualitative findings,literature analysis and expert consultation.In June 2020,70 patients with chronic obstructive pulmonary disease were selected in the Nanyang New Village community of Zhengzhou as the research objects.The residential grouping method was adopted and Nongye road was the boundary.The experimental group consisted of 35 patients living in three communities south of Nongye road,while the control group consisted of 35 patients living in three communities north of Nongye road.The intervention group received self-service lung rehabilitation training for 16 weeks,including health empowerment education,aerobic,resistance,yoga and music imaging training.The control group received 16 weeks health education and community routine COPD intervention.Descriptive statistics,t test,chi-square test,rank sum test and generalized estimation equation were used to compare the training compliance,exercise endurance,respiratory function and quality of life of the two groups before and after the intervention.Results1.Cognitive needs for pulmonary rehabilitation training in older adults with COPDThrough the semi-structured interview with 13 interviewees,the content of the interview was studied repeatedly after the interview,and a summary analysis of the main themes.the themes that affect the participation of COPD patients in pulmonary rehabilitation were finally obtained,including two categories,four themes and eight sub-themes.the rehabilitation project factors include: lack of charm,insufficient empowerment;personal factors include: lack of motivation,physical limitations;eight sub-themes are: lack of fun,lack of professional guidance,lack of initiative,too single training,recognition Lack of knowledge,loss of confidence,the effects of disease,and gradual weakness.2.Intervention study of self-service pulmonary rehabilitation on elderly patients with chronic obstructive pulmonary disease at homeA total of 4 cases were lost during the intervention period,including 2 cases in the intervention group and 2 cases in the control group.In the end,a total of 70 cases of intervention were completed,including 35 cases in the intervention group and the control group.1.After the intervention,the exercise compliance of patients in the intervention group was significantly improved(P<0.05).Compared the results of pre-intervention with the result of 7th and 16 th week,it was found that the patient’s exercise compliance questionnaire score increased significantly,and the difference was statistically significant(P<0.05).Compared with the results of the 16 th week and the 7th week,the patient’s exercise compliance questionnaire score increased significantly,and the difference was statistically significant(P<0.05).After the analysis of the generalized estimation equation,the results showed that the differences in the group effect,time effect and interaction effect of the exercise compliance questionnaire score were statistically significant(P<0.05).2.After the intervention,the exercise tolerance of patients in the intervention group was significantly improved(P<0.05).The grip strength improved from(21.09 ± 4.52)kg to(24.78 ± 5.36)kg.The 6MWT increased from(260.43 ± 34.51)m to(308.66 ± 49.00)m.After the intervention,both the grip strength values and 6MWT distance increased significantly compared with these before the intervention,and the differences were statistically significant(P < 0.05).After the analysis of the generalized estimation equation,the results showed that the differences in the time effect and interaction effect of grip strength were statistically significant(P < 0.05),but the group effect was no significant difference(P > 0.05).The differences in group effect,time effect and interaction effect of 6MWT were statistically significant(P < 0.05).3.After the intervention,the respiratory function of the intervention group was significantly improved(P < 0.05).FEV1 / FVC(%)increased from 60.46 ± 4.32 to 65.26 ± 5.20,FEV1 % pred increased from 77.36 ± 4.98 to 81.63 ± 5.73,and m MRC decreased from 1.94 ± 0.84 to 0.69 ± 0.87.After the intervention,FEV1 / FVC(%),FEV1 % pred measurement and m MRC scores were improved significantly compared with these before intervention,and the difference were statistically significant(P <0.05).The generalized estimation equation analysis showed that the time effect and interaction effect of FEV1 / FVC(%)and FEV1 % pred measurements were statistically significant(P < 0.05),but the group effect was no significant difference(P > 0.05).The differences in group effect,time effect and interaction effect of m MRC scores were statistically significant(P < 0.05).4.After the intervention,the quality of life of patients in the intervention group was significantly improved(P<0.05).The total quality of life(CAT)was reduced from 17.77±6.68 to 9.14±5.21,and the scores in all dimensions were also reduced.After the intervention,the total CAT score,subjective symptoms,subjective psychology,and tolerance scores were improved significantly compared with these before intervention,and the difference were statistically significant(P < 0.05).The results of generalized estimation equation analysis showed that the differences of CAT total score,subjective psychology and tolerance ability scores between groups effect,time effect and interaction effect were statistically significant(P < 0.05).The differences in time effect and interaction effect of subjective symptom scores were statistically significant(P < 0.01),but the group effect was no significant difference(P > 0.05).Conclusions1.At present,the rehabilitation training experience of elderly patients with COPD at home is not ideal,and there are many rehabilitation training needs.It is necessary to develop self-service rehabilitation training programs according to the rehabilitation needs and psychological characteristics of elderly patients.2.The self-service pulmonary rehabilitation training program is a scientific,effective and easy-to-operate intervention measure.This program can improve the exercise compliance of patients,enhance the exercise endurance of patients,especially the endurance of upper and lower limbs,at the same time improve the respiratory function of patients,and ultimately improve the quality of life of patients.2.Self-service rehabilitation training can give full play to the subjective initiative of patients,improve patient participation,save human resources,and reduce the work pressure of community medical staff.This program is worthy of promotion among patients with COPD in the community. |
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