Devine E C, Pearcy J
School of Nursing, University of Wisconsin-Milwaukee 53201, USA.
Patient Educ Couns. 1996 Nov;29(2):167-78. doi: 10.1016/0738-3991(96)00862-2.
Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxation-alone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.
我们对65项关于教育、运动和/或心理社会支持（以下简称心理教育护理）对慢性阻塞性肺疾病（COPD）成人患者影响的研究进行了荟萃分析，这是一项定量研究综述。研究的发表日期从1954年至1994年不等。只有34%的研究将受试者随机分配到治疗组，只有15%的研究设有安慰剂对照组。按治疗类型分析表明，肺康复（大肌肉运动、教育以及各种心理社会或行为干预措施）对心理健康（d+ = 0.58，n = 13）、耐力（d+ = 0.77，n = 13）、功能状态（d+ = 0.63，n = 8）、最大摄氧量（d+ = 0.56，n = 5）、呼吸困难（d+ = 0.71，n = 10）和依从性（d+ = 1.76，n = 2）具有统计学显著的有益效果。未发现肺康复对1秒用力呼气量有统计学显著的有益效果。在所研究的7项结果中，仅包含教育的治疗方法对吸入器使用技能的准确性有显著有益效果（d+ = 1.27，n = 7）。基于非常少的研究样本，仅教育对医疗保健利用率（d+ = 0.26，n = 3）和治疗方案依从性（d+ = 0.50，n = 2）有不显著但较小或中等程度的效果。这些结果尚无定论，表明可能需要进一步研究。仅放松对呼吸困难（d+ = 0.91，n = 3）和心理健康（d+ = 0.39，n = 6）均有统计学显著的有益效果。该研究基础存在方法学上的弱点，应在未来研究中加以纠正。尽管如此，基于目前可得的最佳证据，已证实所确定的心理教育护理类型可改善COPD成人患者的功能和健康状况。
