Transcript The Effects of Respiratory Rehabilitation of Nursing

The Effects of Respiratory Rehabilitation
Program on Six-Minute 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)
• The seventh for 10 causes of death in the
elderly population of 65-year-old (Department
of Health,2009)
• 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 due to
mucus production, coughing, wheezing, and
gas changes.
(Irwin & Madison, 1998)
• Dyspnea, fatigue, cough, anxiety, and 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)
• Respiratory rehabilitation are 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-minute
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 chest hospital in southern Taiwan
• Data collected from November 2011 to April
2012.
• Intervention was respiratory rehabilitation, and
follow up baseline(1st admitted day) , after, 2nd ,
3rd 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, pneumothorax
(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 al.,2010), and selfmanagement (Clary, Janz, Dodge & Sharp,
1991).
• Postural drainage and percussion was used
chest precursor twice, and each times was 30
minutes through nurse do it, at at admitted at
1st , 2nd , 3rd ,and 4th day .
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Respiratory rehabilitation program(ii)
• Pursed-lip breathing tool for pursed-lip
breathing training at admission during day-today activities.
• Teaching upper arm exercise and inhalation
management for 30 min.
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Respiratory rehabilitation program(iii)
• Self-management program workbooks
(1) Pointed out lung lesion on lung anatomy pictures,
and to evaluate postural drainage position.
(2) To record and appraisal sputum amount, and color.
(3) To evaluate respiratory patterns
(4) To evaluate pursed-lip breathing correctness , and
benefit.
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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: on the 1st admission day .
• Variables:
– Demographic data: age, sex, education, marriage,
BMI, chronic disease
– Social data：smoking status
– Lung function: peak expiratory flow
• Outcome:
– Six-minute walking distance (6MWD)
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Statistical analysis(i)
• Descriptive statistics : Test of the 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- Demographic profiles(i)
Variable
Control Groups
n(%)
M±SD
respiratory rehabilitation
group
M±SD
n(%)
Sex
p
0.572
Male
Femal
Age
High
Body Weight
BMI
Marry
No
Yes
Education
No
Primary school
Junior school
High school
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37(71.20%)
15(28.80%)
35(66.00%)
18(34.00)
70.17±10.48
158.64±6.862
58.88±9.144
23.80±3.748
66.53±10.18
159.45±7.69
58.82±10.62
23.25±4.01
4(7.70%)
48(92.30%)
0.074
0.571
0.976
0.47
0.387
2(3.8%)
51(94.3%)
0.832
15(28.80%)
28(53.80%)
7(13.50%)
2(3.80%)
15(28.3%)
27(50.90%)
10(18.90%)
1(1.9%)
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Results- Demographic profiles(ii)
respiratory
rehabilitation group
Control Groups
Variable
n(%)
M±SD
n(%)
Chronic disease
p
M±SD
0.136
NO
14(26.90%)
8(15.1%)
Yes
38(73.1%)
45(84.9%)
Smoking
0.206
No
25(48.1%)
32(60.4%)
Yes
27(51.9%)
21(39.6%)
Peak flow
142.27±62.17
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126.13±64.61 0.195
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Compare with 6MWD in the
pretest and post effect
Control group
n=52
Respiratory
rehabilitation group
n=53
M±SD
M±SD
1st day admission
(baseline)
185.00±81.858
199.13±88.479
0.398
2nd day admission
192.46±77.025
220.35±90.52
0.093
3rd day admission
205.57±73.439
255.98±81.45
0.001
4th day admission
212.04±70.931
275.09±77.202
0.000
time
P
*Independent-T
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The increasing of 6MWD from
baseline after admission
time
Control group n=52
M±SD
P
Respiratory
rehabilitation group
n=53
M±SD
P
2ndday admission
7.46±21.14
3rd day admission
20.57±35.32 ＜0.001 56.85±54.29 ＜0.001
4thday admission
27.04±44.31 ＜0.001 75.96±64.84 ＜0.001
0.014 21.22±38.93 ＜0.001
Paired-T
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The difference of the incensement
of 6MWD from baseline after admission
between 2 groups
time
1st(baseline) -2ndday
admission
1st(baseline) -3rdday
admission
1st(baseline) -4thday
admission
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Control group
n=52
Respiratory
rehabilitation
group n=53
M±SD
M±SD
P*
7.46±21.43
21.22±38.93 0.001
20.57±35.32
56.85±54.29 0.050
27.04±44.31
75.96±64.84 0.024
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*Independent-T
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The interaction between time and groups effect
on 6MWD
Variables
Control
group
n=52
F
Time Effects
p
Respiratory
rehabilitation
group n=53
F
6.53 0.001 23.54
p
F
p
p
0.000
6.18 0.010
Group Effects
Interaction
between Time and
Groups
14.7
0.000
5
Note:*p＜0.05; **p＜0.01; ***p＜0.001
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F
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Repeated ANOVA
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Discussion-Comparison of intervention effect(i)
• 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)
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Discussion-Comparison of intervention effect(ii)
• 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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Discussion- Intervention time the
effectiveness of comparison(i)
• 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-minute walking
distance increased more than control group.
• Change over time, experimental group on sixminute 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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