Grosbois J-M, Valentin M-L, Valentin V, Wallaert B, Le Rouzic O
FormAction Santé, rue de Pietralunga, 59840 Pérenchies, France.
Pneumologie et immuno-allergologie, centre des compétences des maladies pulmonaires rares, CHU de Lille, 59000 Lille, France.
Rev Mal Respir. 2019 Jan;36(1):39-48. doi: 10.1016/j.rmr.2018.10.009. Epub 2019 Jan 7.
Competence in personal relationships is essential for a caregiver, especially in pulmonary rehabilitation (PR). Considering the behavioral profile of patients might help to optimize their management and the results of PR.
We evaluated eight hundred and thirty-two consecutive patients with chronic respiratory disease who received eight weeks of home-based PR. Their exercise tolerance (six-minute stepper test, 6MST), mood (HAD), and quality of life (VSRQ, MRF28) were evaluated at the beginning and end of PR. For six hundred and ninety patients, a behavioral approach was implemented at the beginning of PR by using the DISC tool to identify four behavioral profiles: dominance, influence, steadiness, conscientiousness. The remaining 142 patients served as the control group.
Subjectively, the therapeutic alliance was more easily established with the behavioral approach. Compared with the control group, patients with the "steadiness" profile were younger (60.7±12 years) and mostly female (52.8%), whereas patients with the "conscientiousness" profile were older (67.5±10.6 years) and mostly male (85.5%). The four behaviorally profiled groups showed no differences in exercise tolerance, mood, or quality of life scores at baseline. Globally, all patients improved their exercise tolerance, mood and quality of life. The percentage of responders to 6MST and VSRQ (>MCID) was 7.5% and 5.3% higher with the behavioral approach. For non-responders to 6MST and VSRQ (<MCID), only patients benefiting from the behavioral approach improved the other parameters studied, patients from control group having exhibited no improvement at all.
The DISC-guided behavioral approach improves the patient-caregiver relationship and achieves better results at the end of PR.
人际关系能力对护理人员至关重要，尤其是在肺康复（PR）中。考虑患者的行为特征可能有助于优化其管理及肺康复效果。
我们评估了832例连续的慢性呼吸道疾病患者，他们接受了为期八周的居家肺康复治疗。在肺康复开始和结束时评估他们的运动耐力（六分钟踏阶试验，6MST）、情绪（医院焦虑抑郁量表，HAD）和生活质量（视觉模拟评分问卷，VSRQ；医学研究委员会28项问卷，MRF28）。对于690例患者，在肺康复开始时采用DISC工具实施行为方法，以识别四种行为特征：支配型、影响型、稳健型、尽责型。其余142例患者作为对照组。
主观上，采用行为方法更容易建立治疗联盟。与对照组相比，“稳健型”特征的患者更年轻（60.7±12岁），且大多为女性（52.8%），而“尽责型”特征的患者年龄更大（67.5±10.6岁），且大多为男性（85.5%）。四个行为特征组在基线时的运动耐力、情绪或生活质量评分无差异。总体而言，所有患者的运动耐力、情绪和生活质量均有所改善。采用行为方法时，6MST和VSRQ的反应者百分比（>最小临床重要差异，MCID）分别高出7.5%和5.3%。对于6MST和VSRQ的无反应者（<MCID），只有受益于行为方法的患者改善了所研究的其他参数，对照组患者则完全没有改善。
DISC指导的行为方法改善了患者与护理人员的关系，并在肺康复结束时取得了更好的效果。
