IFSMT-based supervised nursing combined with moderate-intensity exercise training for pulmonary rehabilitation in...

To investigate the effects of supervised nursing combined with moderate-intensity exercise training based on the Individual and Family Self-Management Theory (IFSMT) on pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease (COPD), and to provide evidence for improving self-management ability, pulmonary function, and quality of life.

Using a convenience sampling method, 112 patients with stable COPD admitted to a hospital in Zhejiang Province, China, were enrolled and randomly assigned to a control group or an intervention group using a random number table, with 56 patients in each group. The control group received routine nursing care for stable COPD, including disease education, medication guidance, and general rehabilitation advice. The intervention group received a comprehensive intervention consisting of supervised nursing combined with moderate-intensity exercise training based on the IFSMT framework. The intervention was implemented across three dimensions-context, process, and outcomes-focusing on enhancement of knowledge and health beliefs and family support integration (context), self-regulation guidance, individualized rehabilitation plan development, moderate-intensity exercise training, and continuous assessment and follow-up (process), as well as social facilitation and dynamic adjustment of the intervention program (outcomes). Before and after the intervention, the Chinese version of the Partners in Health scale (PIH), the Chinese-modified Fatigue Impact Scale (FIS), Borg dyspnea scale, and the 6-min walk distance (6MWD) were used to quantitatively assess and compare self-management ability, fatigue severity, pulmonary function, and exercise capacity between the two groups.

After systematic data collection, data management, and statistical analysis, the results showed that post-intervention forced expiratory volume in one second (FEV₁) was higher in the intervention group than in the control group [1.05 (0.87, 1.40) vs. 0.89 (0.66, 1.17), Z = -2.91, p = 0.004]. Forced vital capacity (FVC) after the intervention was also significantly higher in the intervention group than in the control group (2.50 ± 0.63 vs. 1.91 ± 0.61, t = -5.06, p < 0.001). In terms of exercise capacity, the 6-min walk distance (6MWD) was significantly greater in the intervention group than in the control group (306.37 ± 91.98 m vs. 257.95 ± 92.08 m, t = -2.78, p = 0.006). Peak expiratory flow (PEF) after the intervention was also higher in the intervention group [4.31 (3.73, 5.99) vs. 2.24 (1.88, 2.92), Z = -7.63, p < 0.001]. Regarding symptom-related outcomes, Borg dyspnea scores were lower in the intervention group than in the control group [2.00 (1.00, 3.25) vs. 4.50 (3.00, 6.00), Z = -6.18, p < 0.001]. COPD Assessment Test (CAT) scores were also significantly lower in the intervention group [12.00 (10.00, 15.00) vs. 20.50 (16.75, 25.00), Z = -7.63, p < 0.001]. For fatigue and self-management outcomes, Fatigue Impact Scale (FIS) scores were significantly lower in the intervention group than in the control group [23.00 (20.00, 28.25) vs. 42.50 (32.25, 56.25), Z = -7.04, p < 0.001]. Similarly, Partners in Health (PIH) scores were lower in the intervention group [29.00 (22.00, 34.00) vs. 37.00 (28.00, 44.50), Z = -3.50, p < 0.001], indicating better self-management ability. In addition, Activities of Daily Living (ADL) scores were significantly lower in the intervention group than in the control group [23.00 (19.75, 25.25) vs. 32.50 (28.00, 38.00), Z = -7.87, p < 0.001], suggesting better functional status. Regarding modified Medical Research Council (mMRC) dyspnea grades after the intervention, in the intervention group, 5.36% (3/56) of patients were classified as grade 0, 57.14% (32/56) as grade 1, 32.14% (18/56) as grade 2, 1.79% (1/56) as grade 3, and 3.57% (2/56) as grade 4. In the control group, 1.79% (1/56) were classified as grade 0, 1.79% (1/56) as grade 1, 53.57% (30/56) as grade 2, 42.86% (24/56) as grade 3, and 0.00% (0/56) as grade 4. Overall, dyspnea severity was significantly lower in the intervention group than in the control group, and the between-group difference was statistically significant (p < 0.001).

The comprehensive intervention integrating supervised nursing and moderate-intensity exercise training based on the Individual and Family Self-Management Theory (IFSMT) may improve self-management ability, reduce disease-related fatigue, enhance pulmonary function and activities of daily living, and improve quality of life in patients with stable COPD. These findings may provide a reference for pulmonary rehabilitation management in this population.