Pulmonology · Medical Literature
IFSMT-based supervised nursing combined with moderate-intensity exercise training for pulmonary rehabilitation in stable COPD: a randomized controlled trial.
Abstract
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.
Clinical relevance
In patients with stable COPD, does a supervised nursing intervention combined with moderate-intensity exercise training structured around the Individual and Family Self-Management Theory (IFSMT) improve self-management ability, pulmonary function, and quality of life compared with routine nursing care? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (parallel-group, two-arm; randomization by random number table; convenience sampling)","setting":"Single tertiary or secondary hospital, Zhejiang Province, China","sampleSize":"n = 112 (intervention: n = 56, control: n = 56)","population":"Adults with stable COPD admitted to a hospital in Zhejiang Province, China; specific GOLD staging, comorbidity profile, age range, sex distribution, and baseline spirometric values not reported in the abstract","intervention":"Comprehensive IFSMT-based supervised nursing combined with moderate-intensity exercise training, implemented across three theoretical dimensions: (1) context — enhancement of disease knowledge, health beliefs, and family support integration; (2) process — self-regulation guidance and individualized rehabilitation planning; (3) outcomes — not fully described in the supplied abstract text","comparator":"Routine nursing care for stable COPD, comprising disease education, medication guidance, and general rehabilitation advice","primaryOutcome":"Not explicitly designated as a single primary endpoint in the supplied abstract; outcomes stated to include self-management ability, pulmonary function, and health-related quality of life","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
Specific quantitative results — including between-group differences, absolute and relative effect sizes, confidence intervals, p-values, and measures of pulmonary function (e.g., FEV₁, FEV₁/FVC, 6-minute walk distance) or quality-of-life scores (e.g., CAT, mMRC, SGRQ) — are not reported in the supplied abstract. The abstract states that the intervention was evaluated across three IFSMT-derived dimensions (context, process, and outcomes) with a focus on knowledge and health beliefs, family support, self-regulation, and individualized rehabilitation planning, but no numerical outcome data were included in the text provided. NNT and NNH cannot be calculated. No adverse events are described.
Practice implications
Based solely on the supplied abstract, it is not possible to determine the magnitude, direction, statistical significance, or clinical importance of any outcome. The study design — a single-center RCT using convenience sampling in one province of China — limits external generalizability to broader COPD populations, including those in different healthcare systems, COPD severity stages, or cultural contexts. The IFSMT framework is a recognized nursing theory for chronic disease self-management that incorporates individual, dyadic, and family-level factors; its application to COPD is theoretically coherent but requires empirical quantification to inform clinical practice. It is not established from this abstract alone which patients benefit most, what the minimum effective dose of exercise intensity or supervision is, or whether observed changes in surrogate measures (if any) translate to clinically meaningful outcomes such as exacerbation rates, hospitalization, or mortality. Only the full published article would allow a complete evidence appraisal. Clinicians should not alter current evidence-based COPD rehabilitation practices on the basis of an abstract alone. __LIMITATIONS__ Only the abstract is available; no numerical outcome data, effect sizes, confidence intervals, or p-values are reported, making evidence appraisal incomplete.,Single-center design in one province of China using convenience sampling severely limits internal validity and external generalizability.,Random number table allocation without description of allocation concealment or blinding of outcome assessors raises risk of performance and detection bias.,No clearly pre-specified single primary endpoint is declared, creating risk of outcome reporting bias.,Follow-up duration is not reported, so durability of any effect is unknown.,Funding source and potential conflicts of interest are not reported.,Sample size of 112 may be underpowered to detect modest but clinically meaningful differences in spirometric or patient-reported outcomes.,Stable COPD patient characteristics (GOLD stage, severity, comorbidities, baseline function) are not described in the abstract, limiting applicability to specific patient subgroups.,Distinction between statistical significance and clinical importance cannot be assessed without reported data.,Convenience sampling introduces selection bias; enrolled patients may not reflect the broader stable COPD population. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This single-center Chinese RCT examined an IFSMT-based supervised nursing and moderate-intensity exercise training program for stable COPD across 112 patients, but the supplied abstract contains no quantitative outcome data, preventing any determination of efficacy or safety. Clinicians should await the full published article with complete results before drawing any conclusions about clinical utility. Current evidence-based pulmonary rehabilitation guidelines should continue to guide practice.