FormAction Santé, 59840 Pérenchies, France.
CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif des maladies pulmonaires rares, 59000 Lille, France.
Respir Med Res. 2020 Mar;77:24-30. doi: 10.1016/j.resmer.2019.12.001. Epub 2020 Jan 23.
Pulmonary rehabilitation (PR) programs are commonly prescribed for patients with severe respiratory disorders, but little is known about how the patient's personality traits influence PR outcomes. We analyzed the response of patients with chronic obstructive pulmonary disease (COPD) to a home-based PR program according to their predominant behavioral profiles using the Dominance - Influence - Steadiness - Conscientiousness (DISC) tool.
This was a retrospective observational study of 335 COPD patients referred by their pulmonologists between January 2010 and December 2015. The DISC behavioral profile was determined at the beginning of the program. Patients received individual supervised sessions at home once a week for 8 weeks, which consisted of exercise training and psychosocial, motivational, and educational support, all tailored to the participant's DISC profile. Exercise tolerance (6-minute stepper test, 6MST), anxiety and depression (Hospital anxiety and depression scale, HADS), and quality of life (Visual simplified respiratory questionnaire, VSRQ) were evaluated immediately before and after the PR program (T0 and T2, respectively) and then 6 and 12 months later (T8 and T14, respectively). Responders were defined as patients who exhibited at least minimal clinically important differences (improvements) from baseline.
Of the 335 COPD patients, 102 (30.4%), 98 (29.3%), 82 (24.5%), and 53 (15.8%) were classified as having predominant D, I, S, and C behavioral traits, respectively. All four patient groups showed significantly (P<0.01) improved performance in the 6MST, HADS, and VSRQ evaluations at T2 (n=300), T8 (n=262), and T14 (n=231) compared with T0, and the proportion of responders in all groups at T8 and T14 was high (∼60%). The percentage of responders differed significantly between groups only at T2, when the S group contained fewer responders on the HADS anxiety subscale. Most patients who did not complete the study were classified as D type (42/102, 41.2%), followed by I (28/98, 28.6%), S (22/82, 26.8%), and C (12/53, 22.6%) types.
The personality profile of COPD patients influenced their adherence to, but not their benefit from, a home-based PR program. The high proportion of patients in all personality groups showing significant improvements in outcomes supports a personalized approach to the design of PR programs.
肺康复（PR）计划通常适用于患有严重呼吸系统疾病的患者，但对于患者的个性特征如何影响 PR 结果知之甚少。我们使用支配-影响-稳定性-尽责性（DISC）工具，根据慢性阻塞性肺疾病（COPD）患者的主要行为特征，分析了他们对家庭为基础的 PR 计划的反应。
这是一项回顾性观察研究，共纳入了 2010 年 1 月至 2015 年 12 月期间由肺病专家转介的 335 名 COPD 患者。在计划开始时确定 DISC 行为特征。患者每周在家中接受一次个人监督的课程，持续 8 周，包括运动训练以及心理社会、动机和教育支持，所有内容均根据参与者的 DISC 特征量身定制。在 PR 计划前后（分别为 T0 和 T2）以及 6 和 12 个月后（分别为 T8 和 T14），评估运动耐量（6 分钟踏步测试，6MST）、焦虑和抑郁（医院焦虑和抑郁量表，HADS）和生活质量（简化视觉呼吸问卷，VSRQ）。将至少有最小临床重要差异（改善）的患者定义为有反应者。
在 335 名 COPD 患者中，分别有 102 名（30.4%）、98 名（29.3%）、82 名（24.5%）和 53 名（15.8%）患者被归类为具有支配型、影响型、稳定型和尽责型行为特征。所有四个患者组在 T2（n=300）、T8（n=262）和 T14（n=231）时，6MST、HADS 和 VSRQ 评估的表现均显著改善（P<0.01），并且所有组在 T8 和 T14 时的反应者比例均较高（~60%）。仅在 T2 时，各组之间的反应者比例存在显著差异，其中稳定型组 HADS 焦虑分量表的反应者较少。未完成研究的大多数患者被归类为 D 型（42/102，41.2%），其次是 I 型（28/98，28.6%）、S 型（22/82，26.8%）和 C 型（12/53，22.6%）。
COPD 患者的个性特征影响他们对家庭为基础的 PR 计划的依从性，但不影响他们从中受益。所有个性特征组的患者中，有很大一部分患者的结果都有显著改善，这支持了 PR 计划设计的个性化方法。
