The effect of teach-back training intervention of breathing exercise on the level of dyspnea, six-minutes walking test and FEV1/FVC ratio in patients with chronic obstructive pulmonary disease; a randomized controlled trial

ABSTRACT

Background

Chronic obstructive pulmonary disease (COPD) is an irreversible pulmonary obstruction. Respiratory exercise training by a feedback-based model besides the routine managements have been considered to perform.

Research design and methods

Eighty exacerbated COPD patients with informed consent were divided to the control group (n = 40) received the routine approach and the intervention group (n = 40) received a teach-back training method (TBTM) of respiratory exercise including diaphragmatic breathing (DB), pursed-lip breathing (PLB), and effective coughing (EC) plus routine approach. The clinical outcomes were evaluated by measurement of the FEV1/FVC ratio, the Borg scale of dyspnea (BSD), and the 6-minute walking test (6MWT) results at the baseline, just after TBTM, and next 3 months.

Results

FEV1/FVC ratio has been indicated the significant improvement followed by TBTM compare to the baseline (p < 0.001). Moreover, the BSD scores in 3-month follow-up after TBTM were significantly lower compared to the baseline (6 ± 1.3 vs. 3.8 ± 0.78, p < 0.001). Although a significant difference was reported in 6MWT distance between two groups after 3-month follow-up (p < 0.001), there was no significant difference immediately after the TBTM (p = 0.992) that suggested a long-term effect of educational intervention on physical activity.

Conclusion

Significant enhancement in the clinical variables can demonstrate the efficacy of the TBTM program in reducing COPD patients’ symptoms.

Trial registration

http//www.irct.ir.Unique identifier: IRCT20181024041449N5.

KEYWORDS:

• Breathing exercises
• COPD
• education

Article highlights

• Breathing exercises increase the strength of the respiratory muscles and improve the movement pattern of the chest and abdomen, enhancing gas exchange.

• Performing breathing exercises improves the functional capacity of the lungs, controls the symptoms, and reduces the need for medication consequently.

• Accomplishing breathing exercises based on teach-back education develops the ratio of FEV1/FVC in people suffering from chronic obstructive pulmonary disease.

• Breathing exercises based on teach-back enhance the measured distance of the six-minute walking test for people with COPD. Also, the six-minute walking test can be introduced as an acceptable indicator to assess the clinical condition of COPD patients tangibly.

• As dyspnea accounts for a major complication in COPD, which senses individually, performing breathing exercises in the right manner taught by the examiner would be effective to alleviate the respiratory distress considerably.

Acknowledgments

The current research arose from an MSc thesis at the Shahrekord University of Medical Sciences, Shahrekord, Iran. Wholeheartedly, we appreciate the Deputy of research and technology, Student Research Committee of Shahrekord University of Medical Sciences, research assistants, and nurses who take part in the study. This trial was also registered in the ethics committee of Shahrekord University of Medical Sciences (code: IR.SKUMS.REC.1397.299) in addition to the IRCT registry which explained in Patients and methods section.

Author contributions

All the authors contributed to perform this research are listed below with their specific role in brief:

Ali Hasanpour Dehkordi: Making the conception, study design, approving the final draft. Sepehr Ebrahimi-Dehkordi: Data interpretation, providing the draft, critical revision, checking the intellectual content, and take part in teaching the patients. Fatemeh Banitalebi-Dehkordi; The main operative examiner and teacher for educational intervention, providing the draft, approving the final draft. Shahriar Salehi Tali: Making the conception, study design, approving the final draft. Soleiman Kheiri: Design, data analysis and the statistical aspect of the research, approving the final draft. Akbar Soleimani Babadi: Data interpretation, approving the final draft.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.