老年COPD病人短期居家肺康复现状及维持预测模型构建

    Current status of short-term home-based pulmonary rehabilitation for elderly COPD patients and construction of a maintenance prediction model

    • 摘要: 目的: 调查老年慢性阻塞性肺疾病(COPD)病人出院后短期居家肺康复的维持现状,分析其影响因素,并构建肺康复维持情况的预测模型。方法: 采用单中心横断面调查设计,结合目的抽样法选取研究对象。选取2023年11月至2024年11月安徽省阜阳市妇女儿童医院收治的COPD病人为研究对象。调查工具包括一般情况量表、改良英国医学研究委员会呼吸困难指数、慢性病自我效能量表、领悟社会支持量表、COPD病人居家肺康复依从性问卷。分析影响COPD病人居家肺康复情况的因素,并构建预测列线图。结果: 共发放问卷167份,回收有效问卷149份,有效回收率为89.22%。肺康复维持现状总均分(3.49±0.48)分,各维度得分排序为服药>日常生活>运动>心理>氧疗。单因素分析显示: 不同年龄、学历、婚姻状况、吸烟情况、患病前运动习惯、接受肺康复教育次数、康复场所、患病年限、合并其他慢性病种类、是否会使用智能手机、自我效能和社会支持组的病人居家肺康复维持好坏差异均有统计学意义(P<0.05~P<0.01)。多因素结果显示,接受肺康复教育次数、康复场所、合并慢性病种类、自我效能和社会支持是导致肺康复维持好坏的影响因素(P<0.05~P<0.01),接受肺康复教育次数≥5次、康复场所在家中和社区、自我效能和社会支持高是肺康复维持的保护因素,合并慢性病种类≥2种是肺康复维持的危险因素。列线图模型的区分度受试者工作特征曲线下面积为0.902(95%CI: 0.838~0.966),显示具有良好的区分度。结论: 老年COPD病人短期居家肺康复总体处于中等水平,应通过加强肺康复教育、优化康复场所支持、提升病人自我效能和社会支持水平,并重点关注合并多种慢性病的病人,以改善肺康复维持情况。

       

      Abstract: Objective: To investigate the maintenance status of short-term home-based pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease (COPD) after discharge, analyze its influencing factors, and construct a prediction model for the maintenance of pulmonary rehabilitation. Methods: A single-center cross-sectional survey design was adopted, and the research subjects were selected in combination with purposive sampling.Patients with COPD admitted to Fuyang Women and Children′s Hospital from November 2023 to November 2024 were selected as the research subjects.The investigation tools included the general condition scale, modified Medical Research Council dyspnea index of the United Kingdom, chronic disease self-efficacy scale, perceived social support scale, and questionnaire on the compliance of COPD patients with home-based pulmonary rehabilitation.The factors influencing the home-based pulmonary rehabilitation of COPD patients were analyzed, and a prediction nomogram was constructed. Results: A total of 167 questionnaires were distributed, and 149 valid questionnaires were retrieved, with an effective recovery rate of 89.22%.The total average score for the current status of pulmonary rehabilitation maintenance was (3.49±0.48) points.The scores of each dimension were ranked as follows: medication>daily life>exercise>psychology>oxygen therapy.Univariate analysis showed that there were statistically significant differences in the maintenance quality of home-based pulmonary rehabilitation across groups stratified by age, educational background, marital status, smoking condition, pre-illness exercise habit, number of times receiving pulmonary rehabilitation education, rehabilitation venue, duration of illness, type of concomitant chronic disease, using smart phone or not, self-efficacy, and social support (P < 0.05 to P < 0.01).Results of multivariate analysis showed that the number of times of receiving pulmonary rehabilitation education, rehabilitation venue, type of concomitant chronic disease, self-efficacy and social support were the influencing factors for the quality of pulmonary rehabilitation maintenance (P < 0.05 to P < 0.01).Number of times of receiving pulmonary rehabilitation education more than or equal to 5 times, rehabilitation venue at home and in the community, high self-efficacy and high social support were the protective factors for pulmonary rehabilitation maintenance, and concomitant chronic disease more than or equal to 2 types was the risk factor for pulmonary rehabilitation maintenance.The area under the receiver operating characteristic curve for the discriminatory performance of the nomogram model was 0.902 (95%CI: 0.838-0.966), indicating good discriminatory performance. Conclusions: Short-term home-based pulmonary rehabilitation for elderly patients with COPD is generally at a moderate level.The pulmonary rehabilitation maintenance should be improved by strengthening pulmonary rehabilitation education, optimizing the support of rehabilitation venue, enhancing patients′ self-efficacy and social support levels, and focusing on patients with multiple chronic diseases.

       

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