从一项 COPD 的随机对照试验分析太极拳对呼吸困难体验的管理效果。
Managing the experience of breathlessness with Tai Chi: A qualitative analysis from a randomized controlled trial in COPD.
机构信息
Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA.
School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, FL, USA.
出版信息
Respir Med. 2021 Aug;184:106463. doi: 10.1016/j.rmed.2021.106463. Epub 2021 May 15.
PURPOSE
Chronic obstructive pulmonary disease (COPD) is associated with dyspnea, decreased physical activity, and reduced quality-of-life. While pulmonary rehabilitation is helpful, maintenance of physical activity afterwards is problematic. We sought to explore qualitatively the multi-dimensional, biopsychosocial experience of patients with COPD who participated in Tai Chi (TC) vs. group walking to facilitate physical activity after pulmonary rehabilitation).
METHODS
We analyzed semi-structured qualitative exit interviews (N = 81) from a randomized controlled trial comparing 6-months TC with a time-matched group walking intervention and usual care control (UC). Transcripts were reviewed by at least 2 independent reviewers utilizing a social constructivist framework and theoretical sampling approach. An in-depth analysis of an exemplar subset was performed to thematic saturation and captured emergent themes within and between groups.
RESULTS
Focused analysis was conducted on 54 transcripts (N = 21 TC, N = 16 Walking, N = 17 UC). Participants were characterized by mean age 68.5 (±8.3) years, GOLD Stage = 3.0 (IQR 2.0-3.0), baseline FEV percent predicted 48.8% (±16.4), and 48.2% female. We identified predominant themes of breathlessness, and associated fear and embarrassment that limited physical activity across all groups. In both TC and walking, participants reported improvements in energy and endurance. Those in TC additionally shared improvements in breathing, mobility, and capacity for daily activities facilitated by body and breath awareness, emotional control and regulation of breathing, and an adaptive reframing of breathlessness.
CONCLUSION
TC promoted physical and mental wellbeing by diminishing fear and embarrassment associated with breathlessness. Results highlight the multimodal characteristics of TC that may facilitate continued physical activity and improvement in quality of life.
目的
慢性阻塞性肺疾病（COPD）与呼吸困难、体力活动减少和生活质量下降有关。虽然肺康复有帮助，但之后维持体力活动是有问题的。我们试图从质的角度探讨参加太极拳（TC）与团体散步的 COPD 患者的多维、生物心理社会体验，以促进肺康复后的体力活动。
方法
我们分析了一项随机对照试验的半结构化定性退出访谈（N=81），该试验比较了 6 个月的 TC 与时间匹配的团体散步干预和常规护理对照（UC）。使用社会建构主义框架和理论抽样方法，由至少 2 名独立审查员审查转录本。对一个范例子集进行深入分析，以达到主题饱和，并在组内和组间捕捉到新兴主题。
结果
对 54 份转录本（N=21 TC，N=16 步行，N=17 UC）进行了重点分析。参与者的平均年龄为 68.5（±8.3）岁，GOLD 阶段为 3.0（IQR 2.0-3.0），基线 FEV 预测百分比为 48.8%（±16.4），女性占 48.2%。我们确定了主要的主题，包括呼吸困难，以及与体力活动受限相关的恐惧和尴尬，这些主题在所有组中都存在。在 TC 和步行中，参与者报告说能量和耐力都有所提高。那些参加 TC 的人还分享了呼吸、移动性和日常活动能力的改善，这是通过身体和呼吸意识、情绪控制和呼吸调节以及对呼吸困难的适应性重新定义来实现的。
结论
TC 通过减少与呼吸困难相关的恐惧和尴尬，促进了身心健康。结果突出了 TC 的多模式特征，这可能有助于持续的体力活动和生活质量的改善。
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