The effects of a telehealth coping skills intervention on outcomes in chronic obstructive pulmonary disease: primary results from the INSPIRE-II study.
The effects of a telehealth coping skills intervention on outcomes in chronic obstructive pulmonary disease: primary results from the INSPIRE-II study.
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DOI：
10.1097/psy.0000000000000101
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发表时间：
2014-10
影响因子：
3.3
通讯作者：
Palmer SM
中科院分区：
文献类型：
--
作者：
Blumenthal JA;Emery CF;Smith PJ;Keefe FJ;Welty-Wolf K;Mabe S;Martinu T;Johnson JJ;Babyak MA;O'Hayer VF;Diaz PT;Durheim M;Baucom D;Palmer SM
慢性阻塞性肺疾病（COPD）与发病率和死亡率增加以及生活质量下降相关。需要新的干预措施来改善慢性阻塞性肺病患者的预后。本研究评估了基于电话的应对技能干预对心理和躯体生活质量以及对慢性阻塞性肺病相关住院和全因死亡率的综合医疗终点的影响。我们进行了一项双中心随机临床试验，在基线和治疗 16 周后进行评估。研究人群包括 326 名年龄在 38 岁至 81 岁之间的慢性阻塞性肺病门诊患者，随机接受应对技能培训 (CST) 或慢性阻塞性肺病教育 (COPD-ED)。患者完成了一系列生活质量 (QoL) 仪器、肺功能测试和功能测量，并接受长达 4.4 年的随访以评估医疗结果。与对照组相比，CST 组的心理生活质量有更大的改善 (P = .001)，包括较少的抑郁 (Cohen's d=0.22 [95%CI 0.08, 0.36]) 和焦虑 (d=0.17 [95%CI 0.02, 0.33])，以及更好的整体心理健康 (d=0.17 [95%CI 0.03, 0.32])，情绪角色功能（d= 0.29 [95%CI 0.10, 0.48]）、活力（d= 0.27 [95%CI 0.11, 0.42]）和社会功能（d= 0.21 [95%CI 0.03, 0.38]）。治疗组互动的显着基线心理生活质量表明，与 COPE-ED 相比，基线生活质量较低的 CST 在心理生活质量方面取得了更大的改善。 CST 参与者的躯体生活质量也表现出更大的改善 (P = .042)，包括肺部生活质量的更大改善 (d= 0.13 [95%CI 0.01, 0.24])、疲劳程度减轻 (d= 0.34 [95%CI 0.18, 0.50]) 和呼吸困难程度减轻 (d= 0.11 [95%CI -0.01, 0.23]），并且在 6 分钟步行测试中步行距离有更大的改善（d= 0.09 [95%CI 0.01, 0.16]）。然而，CST（34 起事件）和 COPD-ED（32 起事件）之间，COPD 相关住院时间或全因死亡率风险没有显着差异（P = 0.430）。远程医疗应对技能培训干预措施在生活质量和功能能力方面产生了具有临床意义的改善，但没有全面改善慢性阻塞性肺病相关的住院风险和全因死亡率。 ClinicalTrials.gov 标识符 NCT00736268
Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life. Novel interventions are needed to improve outcomes in COPD patients. The present study assessed the effects of a telephone-based coping skills intervention on psychological and somatic quality of life and on the combined medical endpoint of COPD-related hospitalizations and all-cause mortality. We conducted a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to Coping Skills training (CST) or to COPD Education (COPD-ED). Patients completed a battery of quality of life (QoL) instruments, pulmonary function tests, and functional measures and were followed for up to 4.4 years to assess medical outcomes. The CST group exhibited greater improvements in psychological QoL compared to controls (P = .001), including less depression (Cohen’s d=0.22 [95%CI 0.08, 0.36]) and anxiety (d=0.17 [95%CI 0.02, 0.33]), and better overall mental health (d=0.17 [95%CI 0.03, 0.32]), emotional role functioning (d= 0.29 [95%CI 0.10, 0.48]), vitality (d= 0.27 [95%CI 0.11, 0.42]), and social functioning (d= 0.21 [95%CI 0.03, 0.38]). A significant baseline psychological QoL by Treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared to COPE-ED. CST participants also exhibited greater improvements in Somatic QoL (P = .042), including greater improvements in pulmonary QoL (d= 0.13 [95%CI 0.01, 0.24]), less fatigue (d= 0.34 [95%CI 0.18, 0.50]), and less shortness of breath (d= 0.11 [95%CI −0.01, 0.23]) and greater improvement in distance walked on the 6 Minute Walk Test (d= 0.09 [95%CI 0.01, 0.16]). However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events) (P= 0.430). A telehealth coping skills training intervention produced clinically meaningful improvements in quality of life and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality. clinicaltrials.gov Identifier NCT00736268