慢性阻塞性肺疾病患者基于手机应用程序辅助式运动训练的效果研究

发布时间：2018-03-03 18:08

本文选题：肺疾病　切入点：肺疾病　出处：《北京协和医学院》2016年硕士论文　论文类型：学位论文

【摘要】：背景：慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者常表现为呼吸困难进行性加重、运动耐力降低,生活质量严重受到影响。运动训练作为肺康复的基石可改善上述症状,目前多倡导家庭环境的运动训练,但同时面临着巨大挑战一患者运动依从性差,运动训练效果不佳。肺康复指南指出可采用远程方式来监督患者在家庭环境中的运动。手机应用程序可通过提供社会支持、提供改变行为的方法指导和信息以及行为反馈,来促进患者行为改变和提高治疗依从性。目的：设计并评价辅助稳定期COPD患者家庭环境运动训练的手机应用程序,探讨其对患者运动依从性、运动耐力、呼吸困难严重程度和生活质量的影响。方法：本研究包括两部分,即手机应用程序(application, App)的开发部分与运动训练干预部分。于2015年1月至2015年10月,与国立阳明大学生物医学信息研究所共同合作进行手机App的开发,手机App包括6个功能模块一运动模块、排行榜模块、运动提醒模块、健康教育模块、问卷模块、统计模块。于2015年7月至2015年12月,便利选取北京市某三级医院呼吸科门诊的72例稳定期COPD患者,采用抓阄方式将患者随机分为干预组和对照组各36例。干预组患者被要求使用手机App在家庭环境中步行运动12周,每周至少5天,每天至少40分钟,运动强度为80%的6分钟步行试验平均速度(中等强度),每月根据患者的6分钟步行试验结果进行运动强度的调整。对照组患者接受相同的运动处方,运动强度由患者感觉中等强度的疲乏为宜,被口头要求在家庭中步行运动12周。在干预前、干预4周、干预12周,采用运动依从性问卷、6分钟步行试验、改良版英国医学研究委员会呼吸问卷、临床慢性阻塞性肺疾患调查问卷分别测量两组患者的运动依从性、运动耐力、呼吸困难严重程度、生活质量。干预12周时对手机App进行评价。结果：干预12周时共完成65例患者的资料收集(干预组33例,对照组32例)。研究结果显示(1)干预4周、12周时,干预组患者的运动完全依从率分别为72.7%、81.8%,对照组仅为37.5%、25.0%,干预组患者的运动依从性显著高于同期对照组(P0.05),干预组患者的6分钟步行距离在干预4周、12周时较干预前显著提高(P0.017),且高于同期对照组(P0.05)；生活质量总平均分、生活质量症状维度得分在干预12周时较干预前显著降低(P0.017),且低于同期对照组(P0.05),干预组患者的呼吸困难严重程度、生活质量功能维度、心理维度较干预前无明显改善,且两组间无统计学差异。(2)患者对手机App表现出较高的接受度和满意度。结论：手机App为COPD人群在家庭环境中运动提供了一种可行的干预方式,它能够提高患者的运动依从性,改善患者的运动耐力和提高患者总体生活质量。
[Abstract]:Background: chronic obstructive pulmonary disease (copd) patients with chronic obstructive pulmonary disease (COPD) are characterized by progressive exacerbation of dyspnea, decreased exercise endurance and serious impact on their quality of life. Exercise training as the cornerstone of pulmonary rehabilitation can improve the symptoms mentioned above. At present, many sports training advocates the family environment, but at the same time, they face a huge challenge: a patient's poor exercise compliance. Exercise training is not working well. The lung rehabilitation guidelines point out that patients can be monitored remotely in their home environments. Mobile phone applications can provide behavioural change methodology guidance and information and behavioral feedback by providing social support. Objective: to design and evaluate the mobile phone application program to assist stable COPD patients with family environmental exercise training, and to explore its compliance and endurance to patients. Effects of dyspnea severity and quality of life. Methods: this study consisted of two parts: the development of the mobile application application (App) and the exercise training intervention. The mobile phone App is developed in collaboration with the National Institute of Biomedical Information of Yangming University. The mobile phone App consists of six functional modules: exercise module, ranking module, exercise reminder module, health education module, questionnaire module. Statistical module. From July 2015 to December 2015, 72 stable COPD patients were selected from respiratory department outpatient department of a level III hospital in Beijing. Patients in the intervention group were randomly divided into intervention group (n = 36) and control group (n = 36). Patients in the intervention group were asked to use mobile phone App to walk in their home environment for 12 weeks, at least 5 days a week, for at least 40 minutes per day. The average speed of the 6-minute walking test with exercise intensity of 80% (moderate intensity) was adjusted monthly according to the patient's 6-minute walking test results. The patients in the control group received the same exercise prescription. The exercise intensity was better than the moderate intensity fatigue, and was asked to walk in the family for 12 weeks orally. Before the intervention, the intervention was 4 weeks, the intervention was 12 weeks, and the exercise compliance questionnaire was used for 6 minutes walking test. The modified British Medical Research Council Respiratory questionnaire and the Clinical chronic obstructive Pulmonary Disease questionnaire measured the exercise compliance, exercise endurance, dyspnea severity of the two groups. Quality of life. Cell phone App was evaluated at 12 weeks of intervention. Results: 65 patients (33 patients in intervention group and 32 patients in control group) were collected after 12 weeks of intervention. The total compliance rate of the patients in the intervention group was 72.71.8 and that in the control group was only 37.50.The compliance of the patients in the intervention group was significantly higher than that in the control group at the same time (P0.05). The 6-minute walking distance of the patients in the intervention group was significantly higher than that before the intervention at the time of 4 weeks and 12 weeks. The quality of life (QOL) was higher than that of the control group (P 0.017), and the average score of quality of life was higher than that of the control group in the same period. At 12 weeks after intervention, the scores of quality of life symptom dimension were significantly lower than that before intervention (P 0.017) and lower than that of control group (P 0.05). The severity of dyspnea, quality of life function dimension and psychological dimension in the intervention group were not significantly improved as compared with those before intervention. There was no statistical difference between the two groups. (2) the patients showed high acceptance and satisfaction with mobile phone App. Conclusion: mobile phone App provides a feasible intervention method for COPD people to exercise in their home environment, and it can improve the patients' exercise compliance. Improve the patient's sports endurance and improve the patient's overall quality of life.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.5

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