Liao Lin-Yu, Chen Huan-Hwa, Chen Fenju, Yang Shunt-Chen
Department of Nursing, Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan.
J Nurs Res. 2025 Oct 1;33(5):e413. doi: 10.1097/jnr.0000000000000698.
Frailty may result in decreased physical functioning and worsen the prognosis of chronic diseases. Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of concurrent frailty. Although pulmonary rehabilitation has demonstrated improvements in COPD outcomes, its impact on patients with frailty and COPD remains unclear.
This study was designed to examine the effects of the pulmonary rehabilitation exercise package (PREP) on frailty, dyspnea, lower extremity muscular endurance (LEME), and walking ability (WA) in older adult COPD patients with frailty.
A single-blind experimental design was used to study 100 elderly COPD patients with frailty, randomly assigned to either the experimental or control group. The experimental group (EG) received the PREP intervention, while the control group (CG) received routine care. The Clinical Frail Scale (CFS) was used to measure frailty, the Modified Medical Research Council scale was used to measure dyspnea, LEME was measured using the 30-second chair stand test, and functional exercise capacity (i.e., walking ability or WA) was measured using the 6-minute walk distance. All measurements were taken at three time points: baseline (preintervention), 1 week postintervention, and 1 month postintervention. Between-group and within-group differences and variations in repeated measurements over time were compared using independent t tests, paired t tests, and generalized estimating equations (GEE).
A total of 91 participants completed the study, with 9 participants lost to follow-up. No significant between-group differences were found at baseline in terms of characteristics, frailty, dyspnea, LEME, and WA. Applying difference-in-differences, the EG outperformed the CG in terms of dyspnea and WA at both 1-week and 1-month follow-ups, while the EG significantly outperformed the CG on all measures at the 1-month follow-up. Within-group comparisons also revealed significant improvements in the EG compared with the CG. Using GEE to examine the interaction, the EG demonstrated significantly better improvements in dyspnea, LEME, and WA than the CG at the 1-month mark.
CONCLUSIONS/IMPLICATIONS FOR FUTURE PRACTICE: The results show that PREP has the potential to significantly improve health in older adults with frailty and COPD by addressing frailty, dyspnea, LEME, and WA. PREP may be implemented as a subacute health care model to manage COPD-related debilitation in hospital settings.
虚弱可能导致身体机能下降，并使慢性病的预后恶化。慢性阻塞性肺疾病（COPD）与并发虚弱的风险增加有关。尽管肺康复已证明可改善COPD的预后，但其对虚弱合并COPD患者的影响仍不明确。
本研究旨在探讨肺康复运动方案（PREP）对老年虚弱COPD患者的虚弱、呼吸困难、下肢肌肉耐力（LEME）和步行能力（WA）的影响。
采用单盲实验设计，对100例老年虚弱COPD患者进行研究，随机分为实验组和对照组。实验组（EG）接受PREP干预，而对照组（CG）接受常规护理。使用临床虚弱量表（CFS）测量虚弱程度，使用改良医学研究委员会量表测量呼吸困难程度，使用30秒坐立试验测量LEME，使用6分钟步行距离测量功能运动能力（即步行能力或WA）。所有测量均在三个时间点进行：基线（干预前）、干预后1周和干预后1个月。使用独立t检验、配对t检验和广义估计方程（GEE）比较组间和组内差异以及随时间重复测量的变化。
共有91名参与者完成了研究，9名参与者失访。在基线时，两组在特征、虚弱、呼吸困难、LEME和WA方面未发现显著差异。采用差异法分析，在1周和1个月随访时，实验组在呼吸困难和WA方面均优于对照组，而在1个月随访时，实验组在所有测量指标上均显著优于对照组。组内比较也显示，与对照组相比，实验组有显著改善。使用GEE检验交互作用，在1个月时，实验组在呼吸困难、LEME和WA方面的改善明显优于对照组。
结论/对未来实践的启示：结果表明，PREP有可能通过解决虚弱、呼吸困难、LEME和WA问题，显著改善老年虚弱合并COPD患者的健康状况。PREP可作为一种亚急性医疗保健模式，在医院环境中管理与COPD相关的衰弱。
