Improving Lung Transplant Outcomes with Coping Skills and Physical Activity

摘要 对于许多晚期肺部疾病患者来说，肺移植是最后可行的治疗方案。 提高他们的生活质量，延长他们的生存时间。随着越来越多的人遭受 对于终末期肺部疾病，肺移植的频率在过去呈指数级增长。 20年来；2016年美国已有超过2500名患者进行了移植，这一数字 预计在未来几年还会增加。尽管外科技术和医疗管理取得了进步， 中位长期存活率稳定在6年左右，令人惊讶的是，精神健康QOL可能不会 移植后明显改善。开发治疗方法以延长生命并提高个人的生活质量 患有晚期肺部疾病是公共卫生的优先事项。功能容量低，体力活动不足，以及 在肺移植后，高度的情绪困扰是常见的，并与 死亡和再次住院的风险。因此，我们假设，改善心理健康和 功能能力将进一步转化为肺移植患者生活质量的改善和医疗结果的改善 收件人。先前的研究表明，应对技能培训(CST)，既是为了教会患者自我 管理技能和更有效地应对与慢性病相关的心理压力，是 对多种慢性疾病有效，包括糖尿病、缺血性心脏病、关节炎和心脏 失败了。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，这是一种更复杂的情况，患者自我管理，定期锻炼，以及 坚持用药是取得成功的关键。我们建议进行一项随机临床试验，比较 为期12周的综合应对技能训练和锻炼(CSTEX)干预加上标准护理 杜克大学150例肺移植门诊患者的移植教育(SOC-ED)研究 大学医学中心和华盛顿大学医学院。拟议的CSTEX干预措施， 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、肺功能监测和 坚持用药，这已被证明与移植受者的医疗结果有关。 治疗前后躯体和精神健康的总体苦恼和生活质量 功能，将被评估。CSTEX对临床结果的影响也将在中位数上进行评估 随访期为2.5年。这项试验的结果可能导致将应对技能培训纳入其中 并将运动推广纳入常规自我管理干预措施，作为提高 肺移植患者的疾病管理、生活质量和医疗结果，并为推广 对其他晚期肺部疾病患者的研究。

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.