Strijbos J H, Postma D S, van Altena R, Gimeno F, Koëter G H
Rehabilitation Hospital Beatrixoord, Haren, The Netherlands.
J Cardiopulm Rehabil. 1996 Nov-Dec;16(6):386-93. doi: 10.1097/00008483-199611000-00008.
Pulmonary rehabilitation programs often show beneficial effects in patients with chronic obstructive pulmonary disease (COPD). These programs are usually hospital-based. This study assesses the feasibility and application of a 12-week Home-Care Rehabilitation Program (HCRP), carried out by general practitioners, physiotherapists, and home-care nurses.
Effects of the HCRP are assessed in 15 COPD patients with moderate to severe airflow limitation (inspiratory vital capacity [IVC]: mean, 75.4 [SD, 13.7] percent predicted, mean FEV1: 45.5 [6.9] percent predicted) and are compared with a stratified and randomized control group (n = 15).
All participating disciplines judged the program to be useful and feasible. Patient compliance with the rehabilitation exercises was high. No major problems concerning the rehabilitation program were reported. After the HCRP, 4-minute walking distance improved significantly from 274 m [61] to 301 m [72] and maximal work load (W max), as measured during an incremental cycle test, increased from 75.3 W [24] to 85.3 W [28]. At equal work levels (W submax) during the cycle test both Borg dyspnea and leg effort scores decreased significantly after the HCRP (6.7 [1.3] versus 4.9 [1.7] and 4.2 [2.0] versus 1.7 [2.5], respectively). Changes in walking distance, dyspnea, and leg effort scores at W submax were significantly different between the two groups. IVC and FEV1 did not change significantly. In the control group, no significant changes in any parameter were observed.
It was possible to design and perform successfully a home-care rehabilitation program, providing both objective and subjective improvements in a group of patients with COPD. A home-care rehabilitation program appears to be a valuable component in the management of COPD patients with a moderate to severe airflow limitation.
肺康复计划通常对慢性阻塞性肺疾病（COPD）患者显示出有益效果。这些计划通常以医院为基础。本研究评估由全科医生、物理治疗师和家庭护理护士实施的为期12周的家庭护理康复计划（HCRP）的可行性和应用情况。
对15例中度至重度气流受限的COPD患者（吸气肺活量[IVC]：平均为预测值的75.4[标准差，13.7]%，平均第1秒用力呼气容积[FEV1]：为预测值的45.5[6.9]%）评估HCRP的效果，并与分层随机对照组（n = 15）进行比较。
所有参与学科都认为该计划有用且可行。患者对康复锻炼的依从性很高。未报告有关康复计划的重大问题。HCRP后，4分钟步行距离从274 m[61]显著提高到301 m[72]，递增式自行车测试期间测得的最大工作负荷（Wmax）从75.3 W[24]增加到85.3 W[28]。在自行车测试中相同工作水平（Wsubmax）时，HCRP后Borg呼吸困难评分和腿部用力评分均显著降低（分别为6.7[1.3]对4.9[1.7]以及4.2[2.0]对1.7[2.5]）。两组在Wsubmax时步行距离、呼吸困难和腿部用力评分的变化有显著差异。IVC和FEV1无显著变化。在对照组中，未观察到任何参数有显著变化。
成功设计并实施家庭护理康复计划是可行的，该计划能使一组COPD患者在客观和主观方面都得到改善。家庭护理康复计划似乎是管理中度至重度气流受限的COPD患者的一个有价值的组成部分。
