Application Study Of Acceptance Commitment Therapy In Pulmonary Rehabilitation Of Patients With Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease（COPD）,as a chronic respiratory disease,which poses a serious burden on life and health.Pulmonary rehabilitation（PR）,as an non-drug intervention,can alleviate the clinical symptoms of the COPD patients.However,low compliance is common among PR patients,which seriously affects the effect of PR.Studies have shown that psychological flexibility can affect patient compliance.Acceptance and Commitment Therapy（ACT）,as a new model to promote individual health behaviors,can improve the psychological flexibility of COPD patients from six aspects:acceptance,cognitive defusion,being present,self as context,values,committed action,and enhance the awareness of pulmonary rehabilitation,and encourage patients to perform behaviors conducive to disease recovery.At present,domestic research on ACT is in the preliminary exploration stage.Therefore,We will explore the effect of ACT on PR in COPD patients to provide theoretical support for expanding the efficacy and benefits of clinical PR.Objective:This study developed an intervention which is ACT combination with PR for COPD patients.The study explored the effects of ACT combined with PR on psychological flexibility,compliance of pulmonary rehabilitation,dyspnea,the adverse psychological states,quality of life and in COPD patients compared with single PR measures,and provided a new reference direction for the clinical practice of COPD.Methods:This study was non-randomized controlled trial involving 200 COPD patients from the Department of respiratory and acute Critical Care Medicine in Changchun,China.56 COPD patients were eventually included in the study and assigned to the intervention group（ACT combined with PR）and control group（routine PR intervention）according to strict natrification criteria.The intervention lasted for 8weeks.Patients were evaluated pre-and post-intervention using a pulmonary function detector,the modified British Medical Research Council Dyspnea Scale,the Comprehensive Assessment of Psychological Flexibility Scale,the Hospital Anxiety and Depression Scale,and the St.George Respiratory Questionnaire.Adherence to pulmonary rehabilitation was recorded 8 weeks after the intervention.T test and non-parametric test in SPSS 24 as the statistical analysis which were used for the research data.Significance for the outcomes were set at a P-value<0.05.Results:1.Comparison of baseline characteristics between the two groupsA total of 6 patients fell off during the study,3 patients in the intervention group were lost to follow-up,1 died in the control group,and 2 patients were lost to follow-up.Finally,50 patients with COPD completed intervention training.The mean age of patients in this group was 65.77±7.73,including 30 males and 26 females,24with GOLD gradeⅡand 29 with GOLD gradeⅢ.The study analyzed the gender,age,BMI,marriage,educational background,per capita family income,type of payment,smoking history,GOLD rating,comorbidities,and number of hospitalizations.There was no statistical difference between the two groups.The groups in psychological flexibility,lung function indicators FEV₁,dyspnea,anxiety and depression,and quality of life showed no significant difference（P>0.05）.2.Intra-group comparison between the two groups（1）Psychological flexibility:After 8 weeks of the intervention,compared to the pre-intervention,there was statistical difference in the total score of psychological flexibility,openness to experience dimension and value action dimension of patients in the intervention group（P<0.05）.There was no statistical difference in behavioral awareness dimension（P>0.05）.There was no statistical difference in the total score of psychological flexibility,openness to experience dimension and behavioral awareness dimension in the control group（P>0.05）,there was only a statistically significant difference in value action dimension（P<0.05）.（2）Lung function and dyspnea:There was no statistically significant difference between the intervention group and the control group after 8 weeks of the intervention as compared to pre-intervention in the changes of the lung function indicator FEV₁and dyspnea degree mMRC（P>0.05）.（3）Anxiety and depression:Both patients in the intervention group and the control group were found to have significantly lower anxiety,depression,and psychological scores after the intervention,compared to the pre-intervention,and the findings were statistically different（P<0.001）.（4）Quality of life:After 8 weeks of the intervention,compared to the pre-intervention,no matter in the intervention group or the control group,the total score,symptom dimension,activity dimension and influence dimension of the quality of life of patients in both groups were significantly improved compared with before the pre-intervention（P<0.05）.3.Intergroup comparison between the two groups（1）Psychological flexibility:After the intervention,patients in the intervention group had significantly higher overall scores on the psychological flexibility openness to experience,and value action dimensions than patients in the control group（P 0.05）.In terms of behavioral awareness,there was no significant difference between the two groups（P<0.05）.In terms of behavioral awareness,there was no significant difference between the two groups（P<0.05）.（2）Compliance:After intervention,32.00%of the study subjects in the intervention group were fully adherent,48.00%were partially adherent and 20.00%were non-adherent,while only 20.00%of the study subjects in the control group were completely adherent,28.00%were partly adherent and 52.00%were non-adherent.Compliance in the intervention group was significantly higher than in the control group（P<0.05）.（3）Lung function and dyspnea:After intervention,no statistical difference was found in the pulmonary function index FEV1 and the degree of dyspnea mMRC between the two groups（P>0.05）.（4）Anxiety and depression:After the intervention,there was no statistically significant difference between the two groups in the psychological condition overall score.However,the intervention group’s level of anxiety and depression was considerably lower than that of the control group（P<0.001）.（5）Quality of life:After intervention,the total score of quality of life and influence dimension of patients in the intervention group were significantly lower than those in the control group（P<0.001）.However,no statistical difference was found in the dimensions of symptoms and activities between the two groups（P>0.05）.4.Comparison of results after adjusting covariatesWhen demographic characteristics were included as covariates,the results of the intergroup comparison showed that the level of the psychological flexibility,the total score of psychological flexibility,openness to experience and value action in the intervention group were significantly higher than those in the control group（P<0.05）.In the dimension of behavioral awareness,no significant difference was found between the two groups（P>0.05）.In terms of pulmonary function parameter FEV₁was still not significant between the two groups（P>0.05）,the level of dyspnea in the intervention group was significantly lower than that in the control group（P=0.048）.In terms of psychology,the level of anxiety and depression in the intervention group was significantly lower than that in the control group（P<0.001）.In quality of life,the total quality of life score and influence dimension score of the intervention group were significantly lower than those of the control group（P<0.001）.No significant difference was found between the two groups in the comparison of symptoms and activity dimensions（P>0.05）.5.Sensitivity and subgroup analysis of outcome indicators in two groups of patientsThe study’s sensitivity analysis showed that there were no statistical differences between the two groups of COPD patients in demographic basic information such as gender,age,BMI,marital status,education level,per capita household income,type of payment,smoking history,GOLD rating,comorbidities,and number of hospitalizations in the past year（P>0.05）.Subgroup analysis in this study showed that both GOLDⅡand GOLDⅢgroups were in the study,there were no significant differences in lung function parameters and degree of dyspnea between the two groups（P>0.05）.The total score of psychological flexibility and value action in the intervention group were significantly higher than those in the control group（P>0.05）.The level of anxiety and depression in the intervention group was also significantly lower than that in the control group（P>0.05）.Meanwhile,the total score of quality of life and influence dimension of patients in the intervention group were significantly lower than those in the control group（P>0.05）.Conclusions:1.The intervention mode of ACT combined with PR can significantly improve the openness to experience and value actions of COPD patients,and can significantly improve the degree of psychological flexibility of patients.2.The intervention mode of ACT combined with PR promotes exercise compliance in COPD patients.3.The intervention mode of ACT combined with PR fails to improve the FEV1index of pulmonary function in COPD patients,it could alleviate the severity of dyspnea.4.The intervention mode of ACT combined with PR can significantly reduce the level of anxiety and depression in patients.5.The intervention mode of ACT combined with PR has significantly improved the disease impact of COPD patients and improved the quality of life of patients.