Improving Lung Transplant Outcomes with Coping Skills and Physical Activity

摘要 对于许多晚期肺部疾病患者，肺移植是最后可行的治疗选择， 改善他们的生活质量（QoL），延长他们的生存期。随着越来越多的人遭受 从终末期肺部疾病，肺移植的频率在过去呈指数级增长， 20年来，2016年美国有2,500多名患者接受了移植， 预计在未来几年将增加。尽管外科技术和医疗管理取得了进步， 中位长期生存期在6年左右趋于稳定，令人惊讶的是，心理健康生活质量可能不会 移植后明显改善。开发治疗方法以延长生命并改善个人生活质量 是公共卫生的优先事项。功能能力低下，缺乏身体活动，以及 肺移植后情绪困扰增加是常见的， 死亡率和再次住院的风险。因此，我们假设，改善心理健康和 肺移植患者的功能能力将进一步转化为生活质量的改善和更好的医疗结局 受惠人士先前的研究表明，应对技能训练（CST），旨在教病人自我， 更有效地科普与慢性病有关的心理压力， 对许多慢性疾病有效，包括糖尿病、缺血性心脏病、关节炎和心脏病 失败然而，CST尚未被评估为促进肺自我管理的干预措施 移植受者，一个更复杂的条件下，病人自我管理，定期锻炼， 药物依从性对成功的结果至关重要。我们提出了一项随机临床试验， 12-一周的联合应对技能训练和运动（CSTEX）干预加标准治疗 在杜克招募的150例肺移植门诊患者的研究样本中进行移植教育（SOC-ED） 大学医学中心和华盛顿大学医学院。拟议的CSTEX干预， 由呼吸治疗师使用mHealth技术提供，旨在减少痛苦和抑郁 并改善关键的健康行为，包括体力活动，监测肺功能， 坚持服药，这已被证明与移植受者的医疗结果有关。 治疗前后，身体和精神健康的总体痛苦和QoL 功能，将被评估。CSTEX对临床结局的影响也将在中位数上进行评估。 随访时间2.5年。这项试验的结果可能会导致将应对技能培训纳入 并将其推广为日常自我管理干预措施，作为提高 肺移植患者的疾病管理、生活质量和医疗结局，并为扩展 其他晚期肺病患者人群的研究。

ABSTRACT For many patients with advanced lung disease, lung transplantation is the last viable treatment option to improve their quality of life (QoL) and extend their survival. With the growing number of individuals suffering from end-stage lung diseases, the frequency of lung transplantation has increased exponentially over the past two decades; more than 2,500 patients have been transplanted in the United States in 2016, a number that is expected to increase in the coming years. Despite advances in surgical techniques and medical management, median long term survival has plateaued at about 6 years, and, surprisingly, mental health QoL may not improve significantly after transplant. Developing treatments to extend life and improve QoL among individuals with advanced lung disease is a public health priority. Low functional capacity, physical inactivity, and heightened emotional distress are common following lung transplantation and are associated with increased risk of mortality and re-hospitalizations. Therefore we hypothesize that improving psychological well-being and functional capacity will further translate into improved QoL and better medical outcomes among lung transplant recipients. Prior research has shown that coping skills training (CST), designed both to teach patients self- management skills and to cope more effectively with psychological stress associated with chronic illness, is effective for a number of chronic conditions including diabetes, ischemic heart disease, arthritis, and heart failure. However, CST has not yet been evaluated as an intervention to facilitate self-management of lung transplant recipients, an even more complex condition in which patient self-management, regular exercise, and medication adherence are critical to successful outcomes. We propose a randomized clinical trial comparing a 12-week combined coping skills training and exercise (CSTEX) intervention with standard of care plus transplant education (SOC-ED) in a study sample of 150 lung transplant outpatients recruited from Duke University Medical Center and Washington University School of Medicine. The proposed CSTEX intervention, delivered by respiratory therapists using mHealth technology, is designed to reduce distress and depression and to improve key health behaviors, including physical activity, monitoring of pulmonary function, and adherence to medication, which have been shown to be related to medical outcomes in transplant recipients. Before and following treatment, overall distress and QoL indicated by both physical and mental health functioning, will be assessed. Effects of CSTEX on clinical outcomes also will be evaluated over a median follow-up period of 2.5 years. Findings from this trial could lead to the incorporation of coping skills training and exercise promotion into routine self-management interventions as cost-effective approaches to enhance disease management, QoL and medical outcomes in lung transplant patients and provide a basis for extending studies to other populations of patients with advanced lung disease.