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

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.