Yang Xiaoyi, Tang Wenfeng, Xu Lian, Chen Ailian, Zeng Fanshu
Department of Cardiothoracic Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
BMJ Open. 2024 Dec 22;14(12):e082933. doi: 10.1136/bmjopen-2023-082933.
Preoperative home based pulmonary rehabilitation (HPR) can reduce postoperative complications in lung surgery patients. This study aimed to investigate the level of adherence to a preoperative HPR programme in high risk patients awaiting lung surgery, and factors influencing adherence.
A mixed methods explanatory sequential design consisting of a quantitative questionnaire survey and a qualitative interview study.
The study was conducted at a tertiary hospital in Chongqing, China.
186 high risk patients awaiting lung surgery were enrolled in the preoperative HPR programme. All 186 patients participated in the quantitative questionnaire survey. 13 of the 186 patients were selected to participate in the qualitative interview study.
Quantitative questionnaire results revealed an adherence rate of 52.3%. Marital status, residence location, exercise habit, smoking index and pulmonary function were identified as independent influencers of adherence (p<0.05). Qualitative interviews identified poor health, lack of family and social support, adverse weather condition, arduous preoperative examination and unfit exercise intensity as barriers to adherence, and perceived health benefits, family support, and flexibility and convenience in exercise time and space as factors encouraging adherence.
High risk patients awaiting lung surgery adhered to preoperative HPR at a moderate level. A tiered approach can be used to develop personalised HPR protocols based on patients' individual needs and situations to improve adherence and maximise the benefits of HPR.
术前居家肺康复（HPR）可降低肺手术患者的术后并发症。本研究旨在调查等待肺手术的高危患者对术前HPR方案的依从程度以及影响依从性的因素。
采用混合方法解释性序列设计，包括定量问卷调查和定性访谈研究。
本研究在中国重庆的一家三级医院进行。
186例等待肺手术的高危患者纳入术前HPR方案。186例患者均参与了定量问卷调查。186例患者中的13例被选入定性访谈研究。
定量问卷调查结果显示依从率为52.3%。婚姻状况、居住地点、运动习惯、吸烟指数和肺功能被确定为依从性的独立影响因素（p<0.05）。定性访谈确定健康状况差、缺乏家庭和社会支持、恶劣天气条件、术前检查繁琐以及运动强度不合适是依从性的障碍，而感知到的健康益处、家庭支持以及运动时间和空间的灵活性和便利性是鼓励依从性的因素。
等待肺手术的高危患者对术前HPR的依从性处于中等水平。可采用分层方法，根据患者的个体需求和情况制定个性化的HPR方案，以提高依从性并最大化HPR的益处。
