背景與目的:慢性阻塞性肺部疾病是由慢性發炎導致呼吸管的窄縮與肺部實質的損 壞所造成不可逆氣流阻塞與呼吸相關症狀。常有的症狀包含呼吸困難、痰液堆積、 胸悶胸緊、容易疲勞等，造成生活品質下降。根據全國衛生組織公布，肺阻塞已在 2019 年成為全球十大死因之第三名，這樣的疾病是值得全國關注的。目前常見的治 療方法包含了戒菸、藥物治療、肺部復健等。其中，肺部復健是由美國胸腔協會所 認證的全面性治療方法，可透過運動與衛教的方式改善患者的生活品質、運動能 力、以及日後長期運動配合度。然而，根據先前的文獻顯示患者因交通問題、行動 不便、對外出的恐懼，造成目前肺部復健配合度的配合度不高。因此，衍生出本研 究的主題，透過居家復健的方式並結合智慧型手機中的通訊軟體之便利，探討復健 配合度，進而改善肺阻塞患者的肺功能、運動能力、生活品質與心肺耐力。 方法:本研究將受試者們分為控制組與介入組，控制組在前測評估後將收到一條彈 力繩與一本內含圖片與詳細復健指引的肺部復健衛教手冊，待六週後再進行後測。 介入組將進行為期六週有監督下的居家肺部復健，我們將受試者以亂數表隨機分配 至兩種不同運動方式，一種為使用上述提及之衛教手冊進行，另一種觀看 YouTube 運動影片。使用手冊的受試者將收到一本衛教手冊並以手機通訊軟體 LINE 接收物 理治療師指派的三種運動項目;選擇影片的受試者每週將收到由 LINE 傳送的 YouTube 影片播放清單，裡面亦含三種運動項目。介入組中每位受試者皆獲得一條 彈力繩與自覺用力係數登記表，物理治療師將進行每週的電話訪問以監測受試者的 運動狀況與復健配合度，根據登記表上的分數更新介入組的運動項目與強度。待六 週後，進行後測評估以分析居家復健帶來之效益。 結果:介入組經過六週監督下的居家肺部復健運動後，吸氣肌與吐氣肌的肌力以及 六分鐘行走測試測得距離都有統計上顯著的增加，並且在吸氣肌肌力的組間差值比 較中，介入組進步與控制組退步幅度也具有顯著差異。在周邊肌肉力量方面，六週 後控制組左右兩邊的手肘屈曲肌力達到統計上顯著下降，並且與介入組右邊手肘屈 曲差值比較下，控制組下降幅度與介入組肌力上升幅度達到統計上顯著差異。在肺 功能、生活品質問卷分數、心肺運動測試數值與其餘肌力比較皆無統計上顯著改善 或退步。最後，此居家復健運動介入的配合度達到與以往文獻符合之百分之七十二 的比例。 結論:此六週居家復健計畫結合目前臺灣常用智慧型手機之通訊軟體，達到遠端介 入與監督的效果，減少肺阻塞病人到院治療的不便以增進肺部復健的配合度，進而 改善呼吸肌的肌力、維持周邊肌肉力量以及增進心肺耐力。 關鍵字:慢性阻塞性肺部疾病、居家復健、肺部復健、YouTube、LINE、通訊軟 體、智慧型手機、肺功能、呼吸肌肌力、心肺運動測試、生活品質、周邊肌肉力 量、六分鐘行走測試、間歇式肌力訓練、間歇式運動訓練、復健配合度。

Background and purpose: Chronic obstructive pulmonary disease (COPD) is the disease causes structural changes which narrowed small airways and destructed lung parenchyma. The patients always have some respiratory symptoms like dyspnea, cough, sputum production, chest tightness, and fatigue easily. Pulmonary rehabilitation (PR) is a comprehensive treatment. Although many papers have proved benefits that PR gains, the drop-out rate still remains high because of patients’ mobility limitation. Tele-rehabilitation is an alternative way to deliver PR and also improve compliance and completion rate. Therefore, this study designed a home-based PR program to discuss the effects of pulmonary functions, exercise capacity and quality of life on COPD patients.
Methods: We divided randomly the participants into unsupervised group and supervised group. The unsupervised group would receive a theraband and education booklets. The supervised group would receive home-based PR program under supervision for six weeks. We randomly assigned the subjects into one of two different ways, videos or booklets to exercise. These patients would receive three kinds of exercises every week and they needed to report the rated perceived exertion scores via LINE. A physical therapist would make weekly phone calls to monitor patients’ compliance. After six weeks, we would arrange post-test assessment to analyze the results.
Results: After six-week home-based PR program under supervision, strengths of respiratory muscles and distance of six-minute walking test (6MWT) showed significantly increased. (p<0.05) Comparing the delta values of inspiratory muscles strength, the degree of the improvements in the supervised group was significantly higher than that in unsupervised group. (p<0.05) At the aspect of peripheral muscle strengths, the strengths of bilateral elbow flexion significantly decreased. (p<0.05) Besides, the delta values in between-group comparison also reached significantly different (p<0.05). Lastly, the compliance of the PR program was up to seventy-two percent
Conclusions: This is a six-week home-based PR program combined with popular communication applications in Taiwan. It was effective to reduce the inconvenience of traveling to hospitals and increase the low compliance of PR. After this intervention, the strengths of respiratory muscles improved, peripheral muscle strengths maintained and distance of 6MWT increased in the supervised group.
Key words: COPD, home-based rehabilitation, pulmonary rehabilitation, YouTube, LINE, communication applications, smartphones, lung functions, respiratory muscles, cardiopulmonary exercise test, quality of life, peripheral muscle strengths, six-minute walking test, interval muscle strengthening exercises, compliance.

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