Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial.

IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Journal of Telemedicine and Telecare Pub Date : 2024-12-01 Epub Date: 2023-03-15 DOI:10.1177/1357633X231156631
Yuyu Jiang, Baiyila Nuerdawulieti, Zhongyi Chen, Jianlan Guo, Pingping Sun, Mengjie Chen, Jinping Li
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Abstract

Introduction: Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR.

Objective: This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence.

Methods: A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes.

Results: A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028).

Conclusions: PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life.

Trial registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

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患者决策辅助工具支持的共同决策干预对患有慢性阻塞性肺病的老年人进行面对面和虚拟混合肺康复治疗的效果:随机对照试验。
导言:越来越多的人提倡远程肺康复,但远程肺康复并不能完全取代慢性病患者的现场服务。慢性阻塞性肺病(COPD)患者对肺康复(PR)的依从性仍然很低。共同决策(SDM)可促进患者参与肺康复决策,帮助患者和医疗服务提供者共同做出符合患者偏好和价值观的知情决策,这对患者坚持肺康复至关重要:本研究旨在为老年慢性阻塞性肺病患者开发一种基于家庭的公关服务的现场和虚拟混合模式,研究患者决策辅助工具(PDA)支持的经常性 SDM 干预对患者坚持公关、康复结果和决策相关结果的有效性,并探索干预对坚持公关的作用机制:共有 78 名老年慢性阻塞性肺病患者被随机分配到 PR 组(39 人)或 PDA-PR 组(39 人)。两组患者均接受了为期 3 个月的面对面和虚拟混合公关干预。主要结果是患者的生活质量和坚持公关的情况。次要结果为呼吸困难症状、运动自我效能、知识和决策相关结果:共有 72 名参与者完成了为期 3 个月的 PR 计划。两组在坚持 PR(p = 0.033)、COPD 评估测试 (CAT) 分数(p = 0.016)和 PR 知识(p p p p = 0.027)方面存在统计学差异。只有 PDA-PR 组的改良医学研究委员会呼吸困难量表(mMRC)评分明显下降(p = 0.011)。两组之间在圣乔治呼吸问卷(SGRQ)得分(p = 0.078)、运动自我调节效能量表(Ex-SRES)得分(p = 0.29)和慢性阻塞性肺病知识(p = 0.086)方面未观察到有统计学意义的差异。PR值得分对坚持PR(p = 0.007)和CAT得分(p = 0.028)有显著影响:结论:PDA支持的复发性SDM干预有助于维持老年COPD患者的PR依从性,在改善生活质量、提高PR知识、决策自我效能、减少决策冲突和决策后悔方面具有优势,但不能改善SGRQ和Ex-SRES。PR值评分影响患者的康复依从性和生活质量:试验注册:中国临床试验注册中心(ChiCTR):试验注册:中国临床试验注册中心(ChiCTR):ChiCTR1900028563;http://apps.who.int/trialsearch/default.aspx。
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来源期刊
CiteScore
14.10
自引率
10.60%
发文量
174
审稿时长
6-12 weeks
期刊介绍: Journal of Telemedicine and Telecare provides excellent peer reviewed coverage of developments in telemedicine and e-health and is now widely recognised as the leading journal in its field. Contributions from around the world provide a unique perspective on how different countries and health systems are using new technology in health care. Sections within the journal include technology updates, editorials, original articles, research tutorials, educational material, review articles and reports from various telemedicine organisations. A subscription to this journal will help you to stay up-to-date in this fast moving and growing area of medicine.
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