Öztürk Betül Özdel, Alpaydın Aylin Özgen, Özalevli Sevgi, Güler Nurcan, Cimilli Can
Clinic of Pulmonary Diseases, İzzet Baysal State Hospital, Bolu, Turkey.
Department of Pulmonary Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey.
Turk Thorac J. 2020 Jul;21(4):266-273. doi: 10.5152/TurkThoracJ.2019.19015.
OBJECTIVES: Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD. MATERIALS AND METHODS: Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters. RESULTS: We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05). CONCLUSION: Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
目的：慢性阻塞性肺疾病（COPD）的管理包括提高应对疾病技能等干预措施。我们旨在研究自我管理培训对中重度COPD患者生活质量和功能参数的影响。 材料与方法：前瞻性招募61例连续的COPD患者。患者被随机分为两组：自我管理培训组（n = 31）和标准治疗组（n = 30）。通过肺量计、COPD评估测试（CAT）、圣乔治呼吸问卷（SGRQ）、医院焦虑抑郁量表（HADS）、改良英国医学研究委员会（mMRC）呼吸困难量表和简短健康调查（SF - 36）对每位患者进行评估。一组物理治疗师、心理学家、肺病专家和营养师通过电话提供自我管理培训和每两周一次的咨询。三个月结束时，使用相同的评估参数对两组进行重新评估。 结果：我们发现自我管理培训组和标准治疗组的基线人口统计学特征无显著差异。我们观察到自我管理培训组在教育课程后，CAT评分降低（p < 0.001）、SGRQ影响评分（p = 0.013）、活动子量表评分（p < 0.001）和总分（p = 0.020），以及HADS焦虑评分（p = 0.012）和抑郁评分（p = 0.014）均降低。还观察到SF - 36身体功能评分显著增加（p = 0.008）。两组的功能参数均未观察到显著改善；然而，自我管理培训组的FEV1变化比对照组更明显（p = 0.017）。接受教育后两组的住院再入院率和1年生存率相似（p > 0.05）。 结论：我们的结果表明，COPD患者的自我管理培训可改善生活质量并减轻抑郁和焦虑症状。因此，至少对于无法使用肺康复设施的COPD患者，自我管理培训应作为肺康复的第一步进行。
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