Effectiveness of simple pulmonary rehabilitation among chronic obstructive pulmonary disease patients, Kanthararom district, Sisaket province.

Abstract

This research and development aimed to develop and evaluate the effectiveness of a simple pulmonary rehabilitation program by an interdisciplinary team for patients with chronic obstructive pulmonary disease at Kantharalak Hospital, Sisaket Province. The study was conducted in three phases: assessment of the existing program, program development, and implementation and evaluation, from November 7, 2024, to September 30, 2025. In the implementation phase, 44 patients with COPD GOLD stages 1-3 receiving services at the COPD clinic of Kantharalak Hospital were purposively selected. The 12-week program was implemented by an interdisciplinary team consisting of physicians, nurses, pharmacists, physiotherapists, and nutritionists. Research instruments included spirometry, the 6-Minute Walk Test (6MWT), the mMRC scale, the CAT score, the satisfaction assessment, and the behavioral adherence assessment, which passed content validity testing (IOC 0.80-1.00) and reliability testing (Cronbach's Alpha 0.89 and 0.78, respectively). Data were analyzed using descriptive statistics for general information and a paired t-test for comparing differences before and after the program, with statistical significance set at α = 0.05. The existing program revealed five major problems: silo working style, incomplete knowledge provision, unclear role definition, inconsistent follow-up, and lack of diverse learning media. The developed program underwent a systematic analysis-design-development process with three main activities: knowledge and counseling provision, practice training, and regular monitoring and evaluation, supported by comprehensive manuals and media. After participating in the program, pulmonary function showed statistically significant improvement in %FEV1 (mean difference = 6.82, 95% CI = 4.76-8.87, p < 0.001). Physical endurance improved, with 6MWT distance increasing by 64.24 meters (mean difference = 64.24, 95% CI = 35.33-93.16, p < 0.001), exceeding MCID, and oxygen saturation increasing by 0.84% (mean difference = 0.84, 95% CI = 0.53-1.15, p < 0.001). Symptoms and quality of life improved, with the CAT score decreasing by 5.61 points (mean difference = -5.61, 95% CI = 4.47-6.76, p < 0.001), exceeding MCID, and the mMRC score decreasing by 0.55 points (mean difference = -0.55, 95% CI = 0.36-0.74, p < 0.001). Disease severity showed patients in GOLD 1 increasing from 56.8% to 72.7%, with no patients remaining in GOLD 3 and Group D after the program. Exacerbations decreased, with patients having no exacerbations increasing from 36.4% to 86.4%. Patient satisfaction was at the highest level (x̄ = 4.67, S.D. = 0.38), with team service satisfaction being highest (x̄ = 4.79). Behavioral adherence was good (x̄ = 83.7%, S.D. = 11.8). Conclusions: The simple pulmonary rehabilitation program by an interdisciplinary team demonstrated promising results in improving pulmonary function, physical endurance, symptoms, and quality of life among COPD patients with statistical significance. Patients also showed high satisfaction and good behavioral adherence. However, as this study did not include a control group, there are limitations in attributing all changes solely to the program intervention.