| Objective:This study investigated 221 patients with the chronic obstructive pulmonary disease(COPD)in the 10 th People's Hospital of Shanghai,Chest Hospital of Shanghai and Lung Hospital of Shanghai to explore the needs and analyze factors which influence the patients with COPD.Qualitative study was conducted with 14 patients with COPD to understand the factors that hinder the implementation of home-based pulmonary rehabilitation.This study is to provide theoretical framework and evidence for better meeting the rehabilitation needs of patients with COPD and design a home-based pulmonary rehabilitation program for patients with COPD.Methods:1.Literature research method: With the help of domestic and foreign databases,the literature on home-based pulmonary rehabilitation of patients with COPD was collected to provide a theoretical framework for the construction of the scale,which was to be made appropriate changes to the items with vague statements in the form of group discussions and the assistance of invited experts.2.Questionnaire method:The self-made questionnaire for home-based pulmonary rehabilitation for patients with COPD,the British Medical Research Council Dyspnea Scale(mMRC Scale),and the Hospital Anxiety and Depression Scale were used in Shanghai from July to November 2019.Questionnaire surveys were performed on221 patients with COPD in three hospitals in Shanghai.A total of 230 questionnaires were distributed,and 221 valid questionnaires were recalled.The effective recovery rate was 96.1%.3.Semi-structured interview method:To interview patients with COPD,to understand the real ideas and opinions of patients with COPD to carry out home-based pulmonary rehabilitation,and to clarify the relevant factors that hinder the development of home-based pulmonary rehabilitation.4.Statistical method:Use SPSS 22.0 to statistically describe the questionnaire data of patients with COPD.Seven-step analysis of Colaizzi phenomenology was used to analyze and organize the interview data of patients with COPD.Results:1.Reliability and validity of the questionnaire: Based on the item selection and expert evaluation of the questionnaire for the pulmonary rehabilitation at home of patients with chronic obstructive pulmonary disease,a survey tool with 6 dimensions and 32 items was developed.The Cronbach's ? coefficients in each dimension are in the range of 0.82 to 0.90,and the overall content validity is 0.981.2.Questionnaire results:(1)The overall needs of the COPD patients for the six dimensions of home-based rehabilitation are,accordingly,the disease assessment needs,scoring(16.12 ± 2.99),respiratory function exercise needs,scoring(17.42 ± 3.25),sports exercise needs,scoring(13.29 ± 2.88),psychological needs,scoring(8.31 ± 2.93),health education needs,scoring(27.83 ± 5.38),home-based rehabilitation development needs,scoring(18.28 ± 4.20),and home-based rehabilitation,scoring(101.25 ± 14.20).The COPD acute exacerbation risk assessment score has the highest score(4.05 ± 1.11),the respiratory function exercise has the highest abdominal breathing score(3.66 ±0.89),and the exercise has the highest score in upper limb exercise score(3.62 ±0.93),the highest score in the psychological needs dimension is the medical staff 's emotional support score(2.99 ± 1.14),and the highest score in the health education needs dimension is the early disease recognition and processing score(3.91 ± 1.09),the highest score in the dimension of home-base rehabilitation acquisition is the online video score(3.63 ± 1.19).(2)Single-factor analysis of variance showed that different ages,marital status,education level,monthly income,ability to pay for medical expenses,way of living,comorbidities,years of illness,number of acute exacerbations of hospitalization,understanding of rehabilitation exercises,exercise habits,degree of breathing difficulties and the degree of anxiety and depression have statistically significant differences in the degree of home-based pulmonary rehabilitation needs of COPD patients(P <0.05).(3)Multiple linear regression analysis shows that per capita monthly income,degree of dyspnea,marital status,understanding of rehabilitation exercise,years of illness,age,depression,and ability to pay for medical expenses have entered the regression equation,which has statistical significance(F= 56.929,p <0.01).3.Qualitative interview results: The qualitative researches on the problems and expectations of home-based pulmonary rehabilitation for patients with COPD are as follows: Theme 1: Forms for patients to obtain home-based pulmonary rehabilitation:Instruction and guidance of medical staff in hospital;Video;COPD companion.Theme 2: Patients' resistance factors for continuous home-based pulmonary rehabilitation: Patients' insufficient awareness of home-based pulmonary rehabilitation;patient health status;negative emotions;personal factors;lack of social support;obstacles related to exercise programs.Theme 3: Benefits of persistence in home-based pulmonary rehabilitation exercises;Theme 4: Expectations for home-based pulmonary rehabilitation exercise(hope for information support and follow-up guidance from professionals;easy-to-understand video)?Conclusions:1.Questionnaire survey:(1)The questionnaire on home-based pulmonary rehabilitation needs of patients with COPD has good reliability and validity.From a dimensional level,COPD patients have the highest demand for health education dimensions and the lowest psychological dimension.From the specific items,COPD patients have the highest demand for acute exacerbation risk assessment,abdominal breathing,upper limb exercise training,emotional support of medical staff,early disease recognition and processing,and online video.(2)Monthly income per capita,degree of dyspnea,marital status,understanding of rehabilitation exercises,years of illness,age,depression,and ability to pay for medical expenses are the main factors that affect the demand for pulmonary rehabilitation at home for patients with chronic obstructive pulmonary disease.2.Qualitative research: The main factors impeding home-based pulmonary rehabilitation of COPD patients are insufficient cognition of home-based pulmonary rehabilitation,patient health status,negative emotions,personal factors,lack of socialsupport,and obstacles related to exercise programs.Patients hope to obtain professional information support and follow-up guidance,and easy-to-understand operation videos to improve the compliance of home-based pulmonary rehabilitation exercises. |
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