Zhang Pan, Zhu Yanan, Wang Yixuan, Zhang Wenhui, Qiao Cheng, Lou Heqing, Liu Yanan, Dong Dongmei, Zhu Xuan, Chen Bi
Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
J Thorac Dis. 2024 Aug 31;16(8):5209-5221. doi: 10.21037/jtd-23-1895. Epub 2024 Aug 26.
The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients.
This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV (% pred)].
In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001).
General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD.
The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).
反馈教学法（TBM），也被称为“示范给我看”法，是一种用于验证患者对已推荐的健康相关信息理解程度的技术，该方法被推荐用于提高健康素养。然而，关于TBM对慢性阻塞性肺疾病（COPD）患者治疗效果的研究有限。因此，本研究旨在探讨TBM干预对COPD患者健康状况的影响。
这项基于社区的真实世界整群随机对照试验纳入了来自中国18个社区的1688例COPD患者。参与者接受TBM加常规护理（UC）或仅接受UC。在干预前，全科医生接受了TBM培训。主要结局指标为采用医院焦虑抑郁量表（HADS）测量的抑郁和焦虑症状。次要结局指标为采用慢性阻塞性肺疾病评估测试（CAT）测量的健康相关生活质量和呼吸困难。使用改良的医学研究委员会（mMRC）呼吸困难量表评估呼吸困难。从医疗记录中提取急性加重和死亡的数据。肺功能以1秒用力呼气量占预测值的百分比[FEV1（%pred）]表示。
干预组（TBM加UC）的853例COPD患者中，共有336例合并抑郁症，而对照组（仅UC）的835例中有329例合并抑郁症。在12个月时，TBM组在HADS抑郁和焦虑分量表评分（分别为HADS-D和HADS-A）上的改善明显大于UC组（t = 8.34，P < 0.001；t = 12.18，P < 0.001）。在12个月时，TBM组的CAT和mMRC评分显著低于UC组（t = 8.43，P < 0.001；t = 7.23，P < 0.001）。在第12个月时，TBM组的急性加重和死亡人数显著低于UC组（平均MCF值分别为0.35和0.56 [差异为0.22；95%置信区间（CI）：-0.41，-0.02；χ² = 9.63，P < 0.001]）。在12个月时，TBM组的FEV1（%pred）显著高于UC组（t = 7.45，P < 0.001）。
全科医生可以使用TBM干预有效减轻COPD患者的焦虑、抑郁和呼吸困难症状，降低急性加重频率和死亡可能性，并改善健康相关生活质量和肺功能。
该试验在中国临床试验注册中心注册（注册号：ChiCTR-TRC-12001958）。
