Dal Corso Simone, Holland Anne E, George Johnson, Abramson Michael J, Russell Grant, Zwar Nick, Bonevski Billie, Perryman Jaycie, Cox Narelle S
Respiratory Research@Alfred, Monash University, Melbourne, VIC, Australia.
Institute for Breathing and Sleep, Melbourne, VIC, Australia.
Chron Respir Dis. 2024 Jan-Dec;21:14799731241307247. doi: 10.1177/14799731241307247.
Pulmonary rehabilitation (PR) is highly effective but underutilised. Pathways to home-based PR (HBPR) from general practice could improve utilisation, but program fidelity in this setting is unknown. This study aimed to explore the fidelity of HBPR in people referred from general practice. Secondary analysis of intervention-group data from two-arm cluster RCT (RADICALS-interdisciplinary intervention for people with COPD including smoking cessation support, home medicine reviews and 8-weeks HBPR). HBPR fidelity assessed by the extent to which exercise training was prescribed according to protocol. Completion of HBPR and contributing factors were determined. 107 participants (68% of intervention group) were referred to HBPR, with = 75 (70%) commencing the program (mean age 68 years, FEV 65% predicted, median mMRC 1). Aerobic training was prescribed according to protocol for 74% of participants in week one, and on average 89% of participants in weeks 2-8. Resistance training was prescribed according to protocol for 98% and 88% of participants (Week 1 and Weeks 2-8, respectively). Rehabilitation completers ( = 57, 76%) were 26 times more likely to have attended the Week 2 phone call (95% CI 2-352). Clinically meaningful improvements were achieved in health-related quality of life (SGRQ) and health status (CAT) following rehabilitation. PR program fidelity can be maintained when delivering HBPR to people with COPD referred directly from general practice. Early engagement with PR may be key to supporting rehabilitation completion.
肺康复（PR）非常有效，但未得到充分利用。从全科医疗转向居家肺康复（HBPR）的途径可能会提高其利用率，但这种情况下项目的保真度尚不清楚。本研究旨在探讨从全科医疗转诊而来的患者接受HBPR的保真度。对双臂整群随机对照试验（RADICALS——针对慢性阻塞性肺疾病患者的跨学科干预，包括戒烟支持、家庭药物审查和为期8周的HBPR）干预组数据进行二次分析。通过根据方案规定进行运动训练的程度来评估HBPR保真度。确定了HBPR的完成情况及影响因素。107名参与者（占干预组的68%）被转诊至HBPR，其中75名（70%）开始该项目（平均年龄68岁，预计第一秒用力呼气容积为65%，改良英国医学研究委员会呼吸困难量表中位数为1）。在第一周，74%的参与者按照方案进行有氧训练，在第2 - 8周，平均89%的参与者如此。在第1周和第2 - 8周，分别有98%和88%的参与者按照方案进行阻力训练。康复完成者（57名，76%）参加第2周电话随访的可能性是未完成者的26倍（95%置信区间2 - 352）。康复后，健康相关生活质量（圣乔治呼吸问卷）和健康状况（慢阻肺评估测试）实现了具有临床意义的改善。当直接从全科医疗转诊慢性阻塞性肺疾病患者接受HBPR时，PR项目保真度可以得到维持。早期参与PR可能是支持康复完成的关键。
