A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD.
A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD.
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DOI：
10.2147/copd.s109820
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发表时间：
2016
影响因子：
2.8
通讯作者：
Walters EH
中科院分区：
文献类型：
--
作者：
Cameron-Tucker HL;Wood-Baker R;Joseph L;Walters JA;Schüz N;Walters EH
慢性阻塞性肺疾病（COPD）患者肺康复（PR）的范围有限，日常体力活动水平低，因此需要增加日常锻炼。本研究评估了电话健康指导针对家庭步行（远程康复）与常规等待时间（常规护理）的比较，随后进行了PR组。COPD患者随机分为远程康复（干预）组或常规护理组（对照组）。由训练有素的护士健康导师提供的远程康复支持参与者在8-12周的时间里在家行走。PR同时提供给两组，包括8周的每周一次的教育和自我管理技能，并有单独的监督练习。在三个时间点收集数据：基线（TP1）、PR前（TP2）和PR后（TP3）。主要结果是通过6分钟步行距离（6MWD）测量体能变化，每个时间点进行两次测试。次要结果包括自我报告的居家步行、健康相关生活质量和健康行为的变化。在65名新兵中，25人在完成PR之前退出。40人平均参加了6(4)次教育课程。17人参加有监督的锻炼（5±2次）。在TP1和TP2之间，对照组的中位6MWD增加了12 (39.1)m，具有统计学意义，而远程康复组没有变化。6MWD在其他时间点或组间无显著变化，任何次要结局也无显著变化。参加监督运动的参与者在6MWD方面没有显著改善，为12.3 (71)m，而其他参与者没有变化，为0 (33)m。在所有时间点，第二次测试的平均6MWD明显大于第一次测试，但没有临床意义。电话指导在家步行对锻炼能力没有任何好处。在每个时间点进行两次6分钟的步行测试可能没有必要。有监督的锻炼对慢性阻塞性肺病患者至关重要。将锻炼纳入日常生活的挑战是巨大的。
With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR. People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors. Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points. Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.