| Purpuse To investigate the status of disease knowledge, self-management behavior, self efficacy and quality of live (QoL) in COPD patients; to analyze influent factors of self efficacy and QoL; to evaluate the effects of a hospital rehabilitation(self-management education) on disease knowledge and self efficacy; to evaluate the effects of a hospital-family simple pulmonary rehabilitation program on self-management behavior, self efficacy and QoL of patients with COPD; to evaluate the follow-ups effects of a hospital-family simple pulmonary rehabilitation program on self-management behavior, self efficacy and QoL of patients with COPD.Method This study was an experimental survey.90COPD patients in the Third Xiang-Ya hospital of Central South University were recruited and randomly assigned into two groups,45in control group and45in experimental group. Patients in experimental group received a hospital-family simple pulmonary rehabilitation program which contained self-management education in hospital and excise training in patients’family. The experiment group took part in a60-80min group activity and received2-3individual health education when in hospital; after they were out of hospital, excise training and follow-ups were received, lasting2month. Excise training contained respiratory training and up and down arm excise training. In experimental group, knowledge, self-management behavior, self efficacy and quality of live (QoL) were assessed at before intervention (T),before out of hospital(T’),after intervention (T0),1month after intervention(T1),3months after intervention(T3) and6months after intervention (T6).In control group, knowledge and self efficacy were were assessed at before intervention (T) and before out of hospital(T’), in order to evaluate the effects of self-management education, and hospital-family simple pulmonary rehabilitation program separately.Results1. Knowledge score in patients with COPD was13.66±3.202. Multiple linear regression analysis indicated culture level, admission times were entered into the regression equation, coefficient of determination was0.684, and correlation coefficient was0.827. Independent samples t test showed that before intervention knowledge score in the experimental group and the control group was not statistically significant (>0.05).2. Among self management behaviors, total time of exercise (minutes/eek) was111.19±63.086, in which time of strentching/strengthenin exercise (minutes/week) was27.18±32.992, time of aerobic exercise (minutes/week) was84±43.85, cognitive symptom management score was0.56±0.18, and physician communication score was1.13±0.365. Mann-Whimey U test showed before intervention comparisons of total time of exercise, time of stretching/strengthening exercise, time of aerobic exercise, cognitive symptom management score, and physician communication score were not statistically significant (P>0.05) between the experimental group and the control group of patients.3. self-efficacy score in patients with COPD was6.36±1.007,symptom management self-efficacy scores were6.76±0.584, the commonness of disease management self-efficacy scores were6.07±0.663. Multiple linear regression analysis indicated culture level, economic status, co-morbidities on quantity entered into the equation, the coefficient of determination was0.256, and correlation coefficient was0.506. Independent samples t test showed that before intervention comparisons of self-efficacy scores, symptom management self-efficacy scores and the commonness of disease management self-efficacy scores were not statistically significant (P>0.05) between the experimental group and the control group.4. Quality of life scores in patients with COPD were67.67±12.306, symptom scores was69.56±16.944, activity score was77.95±17.225,and affect scores was64.94±19.339. Multiple linear regression analysis indicated age, classification of pulmonary dysfunction, co-morbidities on quantity, and self-efficacy score entered into equations. Independent samples t test showed that before intervention comparisons of the total scores of quality of life, symptoms scores, activity scores, and effect scores showed no significant differences (P>0.05) between the experimental group and the control group.5. Pearson correlation analysis showed that every dimension score of self-efficacy scores and every dimension score of quality of life was negatively related (P＜0.05or P＜0.01).6. Paired t test showed that comparisons of knowledge scores was statistically significant (P<0.05) between before and after hospital rehabilitation programme (i.e. self management health education) in both the experimental group and the control group. Independent samples t test indicated, comparisons of the difference of knowledge scores between before and after hospital rehabilitation program (i.e. self management health education) was statistically significant (P<0.05) between the experimental group and the control group.7. paired t test showed that, comparisons of self-efficacy scores (SE), symptom management self-efficacy score (SE1), the commonness of disease management self-efficacy score (SE2) were statistically significant (P<0.05) between before and after hospital rehabilitation program (i.e. self management health education) in both the experimental group and the control group. Independent samples t test indicated, comparisons of the difference of SE, SE1, SE2between before and after hospital rehabilitation program (i.e. self management health education) was statistically significant (P＜0.05) between the experimental group and the control group.8. Wilconox sign-rank test showed, after hospital-family simple pulmonary rehabilitation program, total time of exercise, time of stretching/strengthening exercise, time of aerobic exercise, cognitive symptom management score, and physician communication score were higher than before in the experimental group, and the difference has statistics significance (P<0.05).9. Paired t test showed that, after hospital-family simple pulmonary rehabilitation program, self-efficacy score (SE), symptom management self-efficacy score (SE1), the commonness of disease management self-efficacy score (SE2) were higher than before in the experimental group, and the difference has statistics significance (P＜0.05).10. Paired t test showed that, after hospital-family simple pulmonary rehabilitation program, total scores of quality of life, symptoms scores, activity scores, effect scores were lower than before in the experimental group, and the difference has statistics significance (P＜0.05).11. Repeated measures analysis of variance showed in follow-ups of simple hospital-family simple pulmonary rehabilitation program, for every dimensions of self management behavior in different time points, comparison of total exercise time (F=61.469, P=0.000), cognitive symptom management score (F=61.495, P=0.000), and physician communication scores (F=89.562, P=0.000) had significant difference.Multiple comparison of total time of exercise, in addition to T1-T3there was no significant difference(P>0.05), comparison between the rest of every two time point were statistically significant(P<0.05); multiple comparison of cognitive symptom management score, comparison of every two time point were statistical significance (P<0.05); multiple comparison of physician communication scores, in addition to T1-T3there was no significant difference(P>0.05), comparison between the rest of every two time point were statistically significant(P<0.05).12. Repeated measures analysis of variance showed in follow-ups of simple hospital-family simple pulmonary rehabilitation program, for every dimensions of self efficacy in different time points, comparison of self-efficacy score (SE)(F=63.744, P=0.000), symptom management self-efficacy score (SE1)(F=68.744, P=0.000), the commonness of disease management self-efficacy score (SE2)(F=18.017, P=0.000) had significant difference.Multiple comparison of self efficacy score, in addition to T-T0,T-T1, T-T3, T-T6there were statistically significant(P<0.05), comparison between the rest of every two time point were no significant difference(P>0.05); multiple comparison of cognitive symptom management score, in addition to T-T0,T-T1, T-T3, T-T6, T1-T6there were statistically significant(P<0.05), comparison between the rest of every two time point were no significant difference(P>0.05); multiple comparison of the commonness of disease management self-efficacy score, in addition to T-T0,T-T1, T-T3, T-T6there were statistically significant(P<0.05), comparison between the rest of every two time point were no significant difference(P>0.05).13. Repeated measures analysis of variance showed in follow-ups of simple hospital-family simple pulmonary rehabilitation program, for every dimensions of quality of life in different time points, comparison of total scores of quality of life(F=89.988, P=0.000), symptom scores(F=70.240, P=0.000), activity scores(F=102.797, P=0.000), effect scores (F=73.709, P=0.000) had significant difference.Multiple comparison of cognitive symptom management score, comparison of every two time point were statistical significance (P<0.05); multiple comparison of symptom scores, in addition to T-T0,T-T1, T-T3, T-T6, To-T3, T0-T6there were statistically significant(P<0.05), comparison between the rest of every two time point were no significant difference(P>0.05); multiple comparison of activity scores, in addition to T-T0,T-T1, T-T3, T-T6, To-T3, T0-T6there were statistically significant(P<0.05), comparison between the rest of every two time point were no significant difference(P>0.05); multiple comparison of effect scores, in addition to T1-T3, T3-T6there were no significant difference (P>0.05), comparison between the rest of every two time point were statistically significant (P<0.05).Conclusion1. Patients with COPD knew well about disease causes and risk factors, but they lack of specific disease management knowledge, and their self management behavior were poor. Therefore, interventions should be taken to improve the knowledge and ability of self management.2. The self-efficacy level in patients with COPD was medium and low, and self-efficacy was related with age, pulmonary function, and complicating diseases; the overall life of quality was not high, and life of quality was related with age, lung function classification, combined disease and self-efficacy. Self efficacy and quality of life were closely related. Self-efficacy sense was high, quality of life was better.3. Hospital rehabilitation program (i.e. self management health education) can significantly improve the level of knowledge and self-efficacy.4. Hospital-family simple pulmonary rehabilitation program can significantly improve self management behavior, enhance self-efficacy, and improve quality of life in patients with COPD.5. Hospital-family simple pulmonary rehabilitation program which contained self-management education can effectively maintain the intervention effect, even contribute its effect of continuous growing.6. Hospital-family simple pulmonary rehabilitation program which aimed to improve self-efficacy, were easily operated, low cost and good effect, is worth popularizing. |
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