Lin-Yu Laio 1 , Jung- Yien Chien 2, Kuei -Min Chen 3 Chest Hospital, Department of Health Executive Yuan 1,2 Ph.D. Stu

1. The Effects of Respiratory Rehabilitation Program on Six Minutes Walking Exercise Test in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Taiwan Lin-Yu Laio1, Jung-Yien Chien2,Kuei-Min Chen3 Chest Hospital, Department of Health Executive Yuan1,2 Ph.D. Student, Kaohsiung Medical University 1 Professor, Kaohsiung Medical University 3 2012/7/31Brisbance oral

2. Jung-Yien Chien2 • Kuei-Min Chen3 2012/7/31Brisbance oral

3. Introduction(i) • The world's third-leading cause of death in chronic obstructive pulmonary disease 2030(WHO,2008) • In Taiwan accounted for 10 causes of death in the elderly population of 65-year-old seventh (Department of Health,2009) • A chronic disease and the main risk factors are exposure to pollution, infection, and cigarette smoking (WHO, 2008) 2012/7/31Brisbance oral

4. Introduction(ii) • Acute exacerbation of COPD often increases mucus production, coughing, and wheezing, due to gas changes. (Irwin & Madison, 1998) • Dyspnea, fatigue, cough, anxiety, decrease exercise capacity are the most common physical symptoms. (Lee, et al., 2010). • Lead to admission or readmission ( Burge & Wedzicha, 2003) 2012/7/31Brisbance oral

5. Introduction(iii) • Pulmonary rehabilitation exercises are a form of non-pharmacologic treatment for maintaining a stable condition and improving the life quality (Minkoff, Leff, & Hilleman, 2005) • Respiratory rehabilitation included • Patient assessment: persistent respiratory symptoms • Exercise training • upper and lower extremity training • Self-management education • Depression, anxiety psychosocial support. ( Linda, Lareau, and Zuwllack,2010). 2012/7/31Brisbance oral

6. Purpose • To evaluate the effects of respiratory rehabilitation program on the six minutes walking distance in COPD patients with acute exacerbation. 2012/7/31Brisbance oral

7. Study design(i) • A quasi-experimental, convenience sample. • Randomized assigned to the experimental and control group. • Stetted at a hospital in southern Taiwan • Data collected from November 2011 to April 2012. • Intervention was respiratory rehabilitation, and follow up baseline(1th admitted day) , after, 2th , 3th and 4th admitted days. 2012/7/31Brisbance oral

8. Study design(ii) • Data collection in the four times, intervention before 1 times and after 3 times. • The medical treatment was standardized in all patients according to GOLD guidelines, included bronchodilators therapy, or intravenous methylprednisolone and antibiotic coverage (Minkoff, Leff, &Hilleman, 2005) in the two groups. 2012/7/31Brisbance oral

9. Participants(i) • Inclusion criteria • COPD with acute exacerbation by physician diagnosis • Age＞18years (3) Conscious clear (4) Speak Chinese (5) Clinical condition stable (6) Get permit 2012/7/31Brisbance oral

10. Participants(ii) • Exclusion criteria (1) Unable to walking (2)Hempotysis (3)Combine had pleural effusion, congestive heart failure, pneumo-thorax (4) Dyspnea induced by Heart disease (5)Spo2≦90 2012/7/31Brisbance oral

11. Sample sizes(i) 2012/7/31Brisbance oral

12. Ethics • This study has been approved by the participating institution’s Ethics Committee. Informed consent was obtained from each patient. 2012/7/31Brisbance oral

13. Respiratory rehabilitation program(i) • Include chest percussion and postural drainage (Lester & Flume,2009), pursed-lip breathing( Lee et, et.al.,2010), and self-management (Clary, Janz, Dodge & Sharp, 1991). • Postural drainage and percussion was used chest precursor twice times and each times was 30 minute through nurse do it, until after admitted1st , 2nd , 3rd and4th day . • Pursed-lip breathing tool for pursed-lip breathing training at admission during day-to-day activities. 2012/7/31Brisbance oral

14. Respiratory rehabilitation program(ii) • Self-management program workbooks • Pointed out that lung lesion on lung anatomy pictures, to correct evaluate postural drainage position, • Record and appraisal sputum amount and color while sputum a little or cough server will be initiative postural drainage. • To correct to do pursed-lip breathing and with the walking and chest physical therapy. • Teaching upper arm exercise and inhalation management for 30 min in prior of hospitalities. 2012/7/31Brisbance oral

15. Pointed out that lung lesion on lung anatomy pictures, to correct evaluate postural drainage position 2012/7/31Brisbance oral

16. Chest precursor 2012/7/31Brisbance oral

17. Postural Drainage 2012/7/31Brisbance oral

18. Pursed-lip breathingtool 2012/7/31Brisbance oral

19. upper arm exercise 2012/7/31Brisbance oral

20. Circle =60m 2012/7/31Brisbance oral

21. Control group • provide and educate chest percussion, postural drainage, pursed-lip breathing and underwent standard medical treatment 2012/7/31Brisbance oral

22. Baseline assessment and outcomes measured(ii) • Time: at the 1th admitted day . • Variables: • Demographic data: age, sex, education, marry, BMI, chronic disease • Social data：smoking status • Lung function: peak expiratory flow • Outcome: • Six minutes walking distance (6MWD) 2012/7/31Brisbance oral

23. Statistical analysis(i) • Descriptive statistics : Test of e distribution • Percentage • Mean • Standard deviation • Chi-square test :Test of homogeneity in two groups 2012/7/31Brisbance oral

24. Statistical analysis(ii) • Independent t-test: Compare the two groups differences in the average. • Repeated ANOVA: Exposure the two groups in the time and six minutes walking distance interaction • A P-value of less than 0.05 was considered significant. 2012/7/31Brisbance oral

25. Results Table 1. Demographic profiles of 105 COPD with AE 2012/7/31Brisbance oral

26. Compare with 6MWD in the pretest and post effect 2012/7/31Brisbance oral

27. Two groups at the time and six minutes walking distance interaction Note:*p＜0.05; **p＜0.01; ***p＜0.001 2012/7/31Brisbance oral

28. Discuss(ii)-Comparison of intervention effect • Improvement of the experimental group than the control group significant. The intervention effect same as the findings of Ghanem, et al.(2010) and Troosters, et al.(2010) • Effective health education materials and process design can effectively resolve troubled by the nurses faced with health education and execution to enhance the effectiveness of health education, The intervention programs same as the findings of Ghanem, et al.(2010). 2012/7/31Brisbance oral

29. Discuss(i)- Intervention time the effectiveness of comparison • After the implementation of two days was significant progress, same as the Clini (2009). • The results show that provide respiratory rehabilitation need two days, can improve exercise tolerance for AECOPD patients in the hospital . 2012/7/31Brisbance oral

30. Conclusion(i) • The experimental group on six minutes walking distance increased more than control group. • Change over time, experimental group on six minutes walking distance increased degree more than control group. 2012/7/31Brisbance oral

31. Conclusion(ii) • Base on the results of this study, Respiratory Rehabilitation of Program improved 6 MWD in the AECOPD patients. • This study implies that the program may provide useful nursing guidance for managing patients with AECOPD. 2012/7/31Brisbance oral

32. Acknowledgements • Thanks the staff、DR. for care patient • Thanks the fund supported for Chest Hospital, Department of Health, Executive Yuan. 2012/7/31Brisbance oral

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35. Thank you 2012/7/31Brisbance oral