Scherer Y K, Schmieder L E
School of Nursing, State University of New York at Buffalo 14214, USA.
Heart Lung. 1997 Jan-Feb;26(1):15-22. doi: 10.1016/s0147-9563(97)90005-4.
To determine the effect of attendance at an outpatient pulmonary rehabilitation (OPR) program on changes in self-efficacy, perception of dyspnea, and exercise endurance in patients with chronic obstructive pulmonary disease (COPD).
Single-group, pretest and posttest design.
A moderate sized, urban private hospital in western New York.
Sixty patients with a diagnosis of COPD. Their ages ranged from 35 to 82 years (mean +/- SD = 65 +/- 0.75 years).
Scores on the COPD Self-Efficacy Scale (CSES) and the Dyspnea Scale and distance walked (feet) on the 12-minute walking-distance test (12 MD).
The OPR consisted of an educational component and exercise training. Methods to increase self-efficacy were integrated into the rehabilitation program. Preprogram and postprogram measurements were obtained on the CSES, the Dyspnea Scale, and the 12 MD.
Paired t tests were used to examine the differences in mean scores between preprogram and postprogram results on the CSES, the Dyspnea Scale, and the 12 MD. There was a significant difference between preprogram and postprogram scores on the CSES (p < 0.01), the Dyspnea Scale (p = 0.01), and the 12 MD (p = 0.04). Pearson product moment correlations showed a significant negative correlation between scores on the CSES and scores on the Dyspnea Scale (r = -0.5566, p = 0.01) and a positive correlation between scores on the CSES and the 12 MD (r = 0.4293, p = 0.05). These results indicated that higher self-efficacy scores on the CSES were correlated with lowered perception of dyspnea and greater distances walked in 12 minutes.
An OPR can improve self-efficacy or confidence in participants' ability to manage or avoid breathing difficulty. Improvement in self-efficacy also may be a factor in decreased perception of dyspnea and increased exercise endurance. Methods to increase self-efficacy expectations with education and exercise training provide an approach to assist persons with COPD to manage their breathing difficulty more effectively. Further studies using a randomized experimental, control design are needed to provide more conclusive direction with regard to effective methods in pulmonary rehabilitation.
确定参加门诊肺康复（OPR）项目对慢性阻塞性肺疾病（COPD）患者自我效能、呼吸困难感知及运动耐力变化的影响。
单组前后测设计。
纽约西部一家中等规模的城市私立医院。
60例诊断为COPD的患者。年龄范围为35至82岁（平均±标准差=65±0.75岁）。
慢性阻塞性肺疾病自我效能量表（CSES）得分、呼吸困难量表得分以及12分钟步行距离测试（12MD）中行走的距离（英尺）。
门诊肺康复包括教育部分和运动训练。提高自我效能的方法融入到康复项目中。在项目实施前和实施后分别对CSES、呼吸困难量表和12MD进行测量。
采用配对t检验来检验项目实施前和实施后CSES、呼吸困难量表及12MD平均得分的差异。项目实施前和实施后CSES得分（p<0.01）、呼吸困难量表得分（p=0.01）及12MD得分（p=0.04）存在显著差异。Pearson积差相关显示，CSES得分与呼吸困难量表得分之间存在显著负相关（r=-0.5566，p=0.01），CSES得分与12MD得分之间存在正相关（r=0.4293，p=0.05）。这些结果表明，CSES上较高的自我效能得分与较低的呼吸困难感知及12分钟内行走更远的距离相关。
门诊肺康复可提高参与者应对或避免呼吸困难能力的自我效能或信心。自我效能的提高也可能是呼吸困难感知降低和运动耐力增加的一个因素。通过教育和运动训练提高自我效能期望的方法为帮助慢性阻塞性肺疾病患者更有效地应对呼吸困难提供了一种途径。需要采用随机实验对照设计进行进一步研究，以提供关于肺康复有效方法的更确凿指导。
