Transcript The Effects of Respiratory Rehabilitation of Nursing

The Effects of Respiratory Rehabilitation
Program on Six Minutes Walking Exercise
Test in Patients with Acute Exacerbation of
Chronic Obstructive Pulmonary Disease in
Taiwan
Lin-Yu Laio1, Jung-Yien Chien2, Kuei-Min Chen3
Chest Hospital, Department of Health Executive Yuan1,2
Ph.D. Student, Kaohsiung Medical University 1
Professor, Kaohsiung Medical University 3
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Jung-Yien
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Chien2
Kuei-Min
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Chen
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Introduction(i)
• The world's third-leading cause of death in
chronic obstructive pulmonary disease
2030(WHO,2008)
• In Taiwan accounted for 10 causes of death in
the elderly population of 65-year-old seventh
(Department of Health,2009)
• A chronic disease and the main risk factors are
exposure to pollution, infection, and cigarette
smoking (WHO, 2008)
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Introduction(ii)
• Acute exacerbation of COPD often increases
mucus production, coughing, and wheezing,
due to gas changes. (Irwin & Madison, 1998)
• Dyspnea, fatigue, cough, anxiety, decrease
exercise capacity are the most common
physical symptoms.
(Lee, et al., 2010).
• Lead to admission or readmission
( Burge & Wedzicha, 2003)
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Introduction(iii)
• Pulmonary rehabilitation exercises are a form of
non-pharmacologic treatment for maintaining a
stable condition and improving the life quality
(Minkoff, Leff, & Hilleman, 2005)
• Respiratory rehabilitation included
– Patient assessment: persistent respiratory symptoms
– Exercise training
• upper and lower extremity training
– Self-management education
– Depression, anxiety psychosocial support.
( Linda, Lareau, and Zuwllack,2010).
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Purpose
• To evaluate the effects of respiratory
rehabilitation program on the six minutes
walking distance in COPD patients with acute
exacerbation.
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Study design(i)
• A quasi-experimental, convenience sample.
• Randomized assigned to the experimental and
control group.
• Stetted at a hospital in southern Taiwan
• Data collected from November 2011 to April
2012.
• Intervention was respiratory rehabilitation, and
follow up baseline(1th admitted day) , after, 2th ,
3th and 4th admitted days.
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Study design(ii)
• Data collection in the four times, intervention
before 1 times and after 3 times.
• The medical treatment was standardized in all
patients according to GOLD guidelines,
included bronchodilators therapy, or
intravenous methylprednisolone and
antibiotic coverage (Minkoff, Leff,
&Hilleman, 2005) in the two groups.
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Participants(i)
• Inclusion criteria
(1) COPD with acute exacerbation by physician
diagnosis
(2) Age＞18years
(3) Conscious clear
(4) Speak Chinese
(5) Clinical condition stable
(6) Get permit
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Participants(ii)
• Exclusion criteria
(1) Unable to walking
(2)Hempotysis
(3)Combine had pleural effusion, congestive heart
failure, pneumo-thorax
(4) Dyspnea induced by Heart disease
(5)Spo2≦90
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Sample sizes(i)
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Ethics
• This study has been approved by the
participating institution’s Ethics Committee.
Informed consent was obtained from each
patient.
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Respiratory rehabilitation program(i)
• Include chest percussion and postural drainage
(Lester & Flume,2009), pursed-lip breathing( Lee
et, et.al.,2010), and self-management (Clary, Janz,
Dodge & Sharp, 1991).
• Postural drainage and percussion was used chest
precursor twice times and each times was 30
minute through nurse do it, until after
admitted1st , 2nd , 3rd and4th day .
• Pursed-lip breathing tool for pursed-lip breathing
training at admission during day-to-day activities.
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Respiratory rehabilitation program(ii)
• Self-management program workbooks
(1) Pointed out that lung lesion on lung anatomy
pictures, to correct evaluate postural drainage
position,
(2) Record and appraisal sputum amount and color
while sputum a little or cough server will be
initiative postural drainage.
(3) To correct to do pursed-lip breathing and with
the walking and chest physical therapy.
(4) Teaching upper arm exercise and inhalation
management for 30 min in prior of hospitalities.
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Pointed out that lung lesion on lung anatomy pictures,
to correct evaluate postural drainage position
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Chest precursor
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Postural Drainage
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Pursed-lip breathing tool
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upper arm exercise
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Circle =60m
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Control group
• provide and educate chest percussion, postural
drainage, pursed-lip breathing and underwent
standard medical treatment
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Baseline assessment and outcomes
measured(ii)
• Time: at the 1th admitted day .
• Variables:
– Demographic data: age, sex, education, marry,
BMI, chronic disease
– Social data：smoking status
– Lung function: peak expiratory flow
• Outcome:
– Six minutes walking distance (6MWD)
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Statistical analysis(i)
• Descriptive statistics : Test of e distribution
– Percentage
– Mean
– Standard deviation
• Chi-square test :Test of homogeneity in two
groups
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Statistical analysis(ii)
• Independent t-test: Compare the two groups
differences in the average.
• Repeated ANOVA: Exposure the two groups in
the time and six minutes walking distance
interaction
• A P-value of less than 0.05 was considered
significant.
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Results
Table 1. Demographic profiles of 105 COPD with AE
Variable
Control Groups
n(%)
M±SD
respiratory rehabilitation
group
M±SD
n(%)
Sex
χ2
t
0.319
Male
Femal
Age
High
Body Weight
BMI
Marry
No
Yes
Education
No
Primary school
Junior school
High school
Chronic disease
NO
Yes
Smoking
No
Yes
Peak
flow
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37(71.20%)
15(28.80%)
15(28.80%)
28(53.80%)
7(13.50%)
2(3.80%)
14(26.90%)
38(73.1%)
25(48.1%)
27(51.9%)
0.572
35(66.00%)
18(34.00)
70.17±10.48
158.64±6.862
58.88±9.144
23.80±3.748
4(7.70%)
48(92.30%)
p
66.53±10.18
159.45±7.69
58.82±10.62
23.25±4.01
1.808
0.569
0.03
0.726
0.748
0.074
0.571
0.976
0.47
0.387
0.871
0.832
2.217
0.136
1.600
0.206
2(3.8%)
51(94.3%)
15(28.3%)
27(50.90%)
10(18.90%)
1(1.9%)
8(15.1%)
45(84.9%)
32(60.4%)
21(39.6%)
142.27±62.17
126.13±64.61
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1.303
0.19525
Compare with 6MWD in the
pretest and post effect
M±SD
Respiratory
rehabilitation group
n=53
M±SD
1st day admission
(baseline)
185.00±81.858
199.13±88.479
0.849 0.398
2nd day admission
192.46±77.025
220.35±90.52
1.698 0.093
3rd day admission
205.57±73.439
255.98±81.45
3.329 0.001
4th day admission
212.04±70.931
275.09±77.202
4.356 0.000
time
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Control group
n=52
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P
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Two groups at the time and six minutes walking
distance interaction
Variables
Control
group
n=52
F
Within Subjects
Effects
pa
Respiratory
rehabilitation group
n=53
F
6.53 0.001 23.54
F
pd
6.18
0.010
F
pe
pb
0.000
Between Subjects
Effects
Interaction between
Subjects Effects
14.75 0.000
Note:*p＜0.05; **p＜0.01; ***p＜0.001
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Discuss(ii)-Comparison of intervention effect
• Improvement of the experimental group than the
control group significant. The intervention effect
same as the findings of Ghanem, et al.(2010) and
Troosters, et al.(2010)
• Effective health education materials and process
design can effectively resolve troubled by the
nurses faced with health education and execution
to enhance the effectiveness of health education,
The intervention programs same as the findings
of Ghanem, et al.(2010).
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Discuss(i)- Intervention time the
effectiveness of comparison
• After the implementation of two days was
significant progress, same as the Clini (2009).
• The results show that provide respiratory
rehabilitation need two days, can improve
exercise tolerance for AECOPD patients in the
hospital .
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Conclusion(i)
• The experimental group on six minutes
walking distance increased more than control
group.
• Change over time, experimental group on six
minutes walking distance increased degree
more than control group.
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Conclusion(ii)
• Base on the results of this study, Respiratory
Rehabilitation of Program improved 6 MWD
in the AECOPD patients.
• This study implies that the program may
provide useful nursing guidance for managing
patients with AECOPD.
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Acknowledgements
• Thanks the staff、DR. for care patient
• Thanks the fund supported for Chest Hospital,
Department of Health, Executive Yuan.
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Thank you
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