Abstract:

Objective: To explore the effectiveness of early rehabilitation exercise guided by transtheoretical model (TTM) in patients with chronic obstructive pulmonary disease (COPD) and frailty. Methods: A total of 116 patients with COPD and frailty admitted to Qingpu Branch of Zhongshan Hospital affilitated with Fudan University from January to August 2023 were selected according to the inclusion criteria, and randomized into a control group and an observation group. After one case of spontaneous pneumothorax was removed, the patients in control group (n=58) were given routine nursing care, while patients in observation group (n=57) were given TTM-guided early rehabilitation exercise combined with routine care. Behavioral changes, frailty score, extent of dyspnea, 6-minute walking distance (6MWD), and quality of life were evaluated and compared between the two groups before and after the intervention. Results: After intervention, the patients in observation group presented significantly lower no-intention-to-change rate in pre-intention period compared with control group (15.79% (9/57) vs. 60.34% (35/58)). Whereas the proportions of patients who had changed behavior and whose behavior change maintained for ≥6 months were significantly higher in observation group compard to control group ((52.63% (30/57) vs. 31.03% (18/58)) and (28.07% (16/57) vs. 3.45% (2/58)), with statistically significant difference (Z=-5.405, P<0.001). The proportions of patients with grade 1 and grade 2 dyspnea in the observation group (28.07% (16/57) and 52.63% (30/57)) were significantly higher than those in control group (24.14% (14/58) and 29.31% (17/58)), while the proportions of patients with grade 3 and grade 4 dyspnea in the observation group (17.54% (10/57) and 1.75% (1/57)) were lower than those in the control group ((37.93% (22/58) and 8.62% (5/58)), with statistically significant differences (Z=-2.312, P=0.021). The patients in observation group demonstrated significantly better outcomes in frailty score, 6MWD, and CAT score compared to the control group (3.14±0.64 vs. 3.88±0.73, (323.75±52.62) m vs. (299.38±61.26) m), 17.07±3.98 vs. 19.00±5.28, the differences were also statistically significant (t=5.784, P<0.001; t=-2.287, P=0.024; t=2.211, P=0.029). Conclusion: TTM-guided early rehabilitation exercise can effectively enhance patients’ willingness to adopt behavioral changes, promote the establishment of their exercise behavior pattern, which ultimately alleviate the dyspnea level and frailty syptoms in COPD patients, and improve quality of life. This model could be recommended in clinical practice.

Key words: Pulmonary disease, chronic obstructive, Frailty, Transtheoretical model, Rehabilitation nursing, Clinical intervention studies