Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Chron Respir Dis. 2019 Jan-Dec;16:1479973119882939. doi: 10.1177/1479973119882939.
Pulmonary rehabilitation (PR) is an evidence-based, low-cost, non-medical treatment approach for patients with chronic respiratory diseases. This study aimed to start and assess the feasibility, acceptability and impact of a PR programme on health and quality of life of respiratory patients, for the first time in primary care in Crete, Greece and, particularly, in a low-resource rural setting. This was an implementation study with before-after outcome evaluation and qualitative interviews with patients and stakeholders. In a rural primary healthcare centre, patients with chronic obstructive pulmonary disease (COPD) and/or asthma were recruited. The implementation strategy included adaptation of a PR programme previously developed in United Kingdom and Uganda and training of clinical staff in programme delivery. The intervention comprised of 6 weeks of exercise and education sessions, supervised by physiotherapists, nurse and general practitioner. Patient outcomes (Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Patient Health Questionnaire-9 (PHQ-9), Incremental Shuttle Walking Test (ISWT)) were analysed descriptively. Qualitative outcomes (feasibility, acceptability) were analysed using thematic content analysis. With minor adaptations to the original programme, 40 patients initiated (24 with COPD and 16 with asthma) and 31 completed PR (19 with COPD and 12 with asthma). Clinically important improvements in all outcomes were documented (mean differences (95% CIs) for CCQ: -0.53 (-0.81, -0.24), CAT: -5.93 (-8.27, -3.60), SGRQ: -23.00 (-29.42, -16.58), PHQ-9: -1.10 (-2.32, 0.12), ISWT: 87.39 (59.37, 115.40)). The direct PR benefits and the necessity of implementing similar initiatives in remote areas were highlighted. This study provided evidence about the multiple impacts of a PR programme, indicating that it could be both feasible and acceptable in low-resource, primary care settings.
肺康复（PR）是一种基于证据的、低成本的非药物治疗方法，适用于慢性呼吸系统疾病患者。本研究旨在首次在希腊克里特岛的基层医疗保健中，特别是在资源匮乏的农村环境中，启动并评估 PR 方案对呼吸疾病患者的健康和生活质量的可行性、可接受性和影响。这是一项实施研究，采用前后结果评估和对患者和利益相关者的定性访谈。在农村初级保健中心，招募了慢性阻塞性肺疾病（COPD）和/或哮喘患者。实施策略包括改编先前在英国和乌干达开发的 PR 方案，并培训临床工作人员提供方案。干预措施包括由物理治疗师、护士和全科医生监督的 6 周运动和教育课程。对患者结局（临床 COPD 问卷（CCQ）、COPD 评估测试（CAT）、圣乔治呼吸问卷（SGRQ）、患者健康问卷-9（PHQ-9）、递增穿梭步行测试（ISWT））进行描述性分析。使用主题内容分析对定性结局（可行性、可接受性）进行分析。在对原始方案进行微小调整后，有 40 名患者开始（24 名 COPD 和 16 名哮喘），31 名患者完成 PR（19 名 COPD 和 12 名哮喘）。所有结局均记录到有临床意义的改善（CCQ 的平均差异（95%CI）：-0.53（-0.81，-0.24）、CAT：-5.93（-8.27，-3.60）、SGRQ：-23.00（-29.42，-16.58）、PHQ-9：-1.10（-2.32，0.12）、ISWT：87.39（59.37，115.40））。强调了 PR 方案的直接益处以及在偏远地区实施类似举措的必要性。本研究提供了 PR 方案的多项影响的证据，表明它在资源匮乏的基层医疗保健环境中既可行又可接受。
