Pulmonary Rehabilitation Program At The Time Of Hospitalization Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

ObjectiveTo apply the Delphi method to develop an in-hospital pulmonary rehabilitation program for hospitalized patients with chronic obstructive pulmonary disease,and conduct quasi-experimental design to test the initial safety,feasibility and effectiveness.Methods(1)Literature research method:Through a large number of literatures and guidelines for pulmonary rehabilitation in hospitalized patients with chronic obstructive pulmonary disease at home and abroad,grasp the research status of the pulmonary rehabilitation program,sort out and analyze the relevant elements of the pulmonary rehabilitation program,and then form a preliminary programs with the expert group discussion.(2)Delphi methods:After two rounds of Delphi expert consultation,the opinions of experts tend to be consistent,the formal program was formed.Then five patients were selected for clinical pre-test,and a rehabilitation program including rehabilitation safety indicators,exercise training,respiratory exercise,and health education was formed.(3)The pulmonary rehabilitation program was used for the quasi-experimental study.The patients in the acute exacerbation of the chronic obstructive pulmonary disease who met the enrollment conditions in the southern ward of the respiratory department of the Affiliated Hospital of Xuzhou Medical University were included as the intervention group,and the patients in the northern ward were the control group.When the patient's general condition got well after admission,pulmonary rehabilitation related health education and some educational papers would be gived to those patients.After meeting the rehabilitation safety index and the vital signs are stable,the lung rehabilitation exercise would be started until the patient is discharged from the hospital.The two groups of patients were measured for grip strength,30S chair stand-up test,forced expiratory volume in one second(FEV1)of lung function,Modified Medical Research Council dyspnea scale(mMRC)score,Barthel score,hospitalization days before and after rehabilitation,and the patient's lung rehabilitation exercise compliance and adverse event rate were calculated after completing the exercise on the day of discharge.The collected data were statistically analyzed using SPSS 19.0 statistical software.Results(1)Through reviewing reference literatures and evidence-based guidelines,the in-hospital pulmonary rehabilitation programs for patients with COPD was formulated,including rehabilitation safety indicators,exercise mode selection,upper limb exercise,lower limb exercise,respiratory exercise,exercise intensity,and review of reference materials and evidence-based guidelines at home and abroad.Health education 7 parts,a total of 32 items.(2)Delphi experts selection:A total of 16 experts from the Jiangsu(Nanjing,Suzhou,Xuzhou,Nantong,etc.),Shanghai third-class hospitals and comprehensive university institutions,including 6 respiratory medicine clinical care,and nursing experts,5 rehabilitation medical and nursing experts,2 cardiopulmonary rehabilitation therapists,3 human body kinematics,sports rehabilitation nursing and rehabilitation nursing education experts;among them,8 persons are senior titles,6 people are deputy senior titles,and 2 are intermediate titles;one of them is post doctor;two of them are doctors,eight of them are masters,five of them are undergraduates,3 of whom have overseas research and learning experience.(3)The results of Delphi experts method:After 2 rounds of experts consultation,the positive coefficient were all 100%,the expert authority was 0.812,The average scores of the importance scores of each item in the 2 rounds fluctuated from 4.44 to 5 points respectively,4.75 to 5 points.the score were all>3.5;The coefficient of variation of each item in 2 rounds fluctuated from 0 to 0.15,0 to 0.09,respectively,the coefficient of variation were all<0.25,and the coordination coefficient were 0.167 and 0.103,the 2 rounds coordination coefficient test was statistically significant,P value were 0.000 and 0.012.Therefore two items were added to the program,the in-hospital pulmonary rehabilitation was formed with a four-parts,34-items.(4)Results of quasi-experimental study:The differences in the grip strength test group were statistically significant,while that control group was not.There were statistically significant difference in the within group between two groups in 30S sit-to-stand test?FEV1?the mMRC and Barthel Index(P<0.05).The 30S sit-to-stand test between the groups was statistically significant(P<0.05).No serious adverse events occured in the pulmonary rehabilitation programs,and the adherence was good,ranged from 75%?100%.ConclusionThe resulting in-hospital pulmonary rehabilitation program for patients with COPD has good safety,feasibility and effectiveness,and can be applied to clinical practice,providing reference for more in-depth research in related aspects in the future.