Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109-2029, USA.
Int J Chron Obstruct Pulmon Dis. 2009;4:61-77. Epub 2009 Apr 15.
A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD) have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a) consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b) identify the type of interventions most associated with outcomes, c) examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d) explore implications for future COPD research. Studies reviewed comprised large scale comprehensive reviews including randomized clinical trials and meta-analysis as these forms of investigation engender the greatest confidence in clinicians and health care researchers. Extant research suggests that the most significant improvements in COPD health care utilization have been realized from interventions specifically designed to enhance disease management by patients. A range of interventions have produced modest changes in quality of life. Evidence of impact for other outcomes and for a particular type of intervention is not strong. Research in other chronic diseases, particularly asthma, suggests that interventions grounded in learning theory and models of behavior change can consistently produce desired results for patients and clinicians. Use of a model of self-regulation may enhance COPD interventions. Although the extent to which COPD efforts can benefit from the experience in other conditions is a question, more outcome focused intervention studies using more robust theoretical approaches may enhance COPD results, especially regarding health care use and quality of life.
过去的一段时间里，开展了许多与慢性阻塞性肺疾病（COPD）临床和社会心理方面相关的优秀干预研究。已经检查了一系列结果，包括肺功能、医疗保健使用、生活质量、焦虑和抑郁、活动能力、运动能力和自我效能。本叙述性综述的目的是：a）根据它们产生的与健康相关的结果，考虑针对 COPD 患者的临床、社会心理和教育干预措施；b）确定与结果最相关的干预措施类型；c）与哮喘相比，根据理论和模型的演变，检查与 COPD 干预措施相关的工作；d）探索对未来 COPD 研究的启示。综述中包括大规模综合综述的研究，包括随机临床试验和荟萃分析，因为这些形式的调查为临床医生和医疗保健研究人员提供了最大的信心。现有的研究表明，通过专门设计的干预措施来增强患者对疾病的管理，在 COPD 医疗保健利用方面取得了最大的改善。一系列干预措施使生活质量有了适度的改善。对于其他结果和特定干预措施的证据并不强。其他慢性疾病，特别是哮喘的研究表明，基于学习理论和行为改变模型的干预措施可以为患者和临床医生带来一致的结果。自我调节模型的使用可能会增强 COPD 干预措施。虽然 COPD 努力可以从其他条件的经验中受益的程度是一个问题，但使用更强大的理论方法进行更多以结果为导向的干预研究可能会提高 COPD 的结果，特别是在医疗保健使用和生活质量方面。
