Applying Extended Theory of Planned Behavior for Lung Cancer Patients Undergone Pulmonary Resection: Effects on Self-Efficacy for Exercise, Physical Activities, Physical Function, and Quality of Life

Yeonjung Lim; Haejung Lee; Do Hyung Kim; Yeong Dae Kim

doi:10.4040/jkan.2020.50.1.66

Journal List > J Korean Acad Nurs > v.50(1) > 1143147

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lim, Lee, Kim, and Kim: Applying Extended Theory of Planned Behavior for Lung Cancer Patients Undergone Pulmonary Resection: Effects on Self-Efficacy for Exercise, Physical Activities, Physical Function, and Quality of Life

Original Article

J Korean Acad Nurs 2020;50(1):66-80.

Published online: 17 January 2020

DOI: https://doi.org/10.4040/jkan.2020.50.1.66

Applying Extended Theory of Planned Behavior for Lung Cancer Patients Undergone Pulmonary Resection: Effects on Self-Efficacy for Exercise, Physical Activities, Physical Function, and Quality of Life

Yeonjung Lim¹, Haejung Lee¹, Do Hyung Kim², Yeong Dae Kim³

¹College of Nursing, Pusan National University, Yangsan

²Pulmonary Medicine Center, Pusan National University Yangsan Hospital, Yangsan

³Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea

Address reprint requests to : Lee, Haejung, College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea, Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: haejung@pusan.ac.kr

Received 7 May 2019 Revised 5 December 2019 Accepted 19 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose:

This study aims to examine the effects of nursing interventions based on the Extended Theory of Planned Behavior (ETPB) regarding self-efficacy for exercise (SEE), physical activity (PA), physical function (PF), and quality of life (QOL) in patients with lung cancer who have undergone pulmonary resection.

Methods:

This quasi-experimental study was conducted between July 2015 and June 2018 in two university-affiliated hospitals. The intervention included pre-operative patient education, goal setting (action and coping planning), and feedback (behavior intention and perceived behavioral control). The intervention group (IG) (n=51) received nursing interventions from the day before surgery to 12 months after lung resection, while the comparison group (CG) (n=36) received usual care. SEE, PA, PF (dyspnea, functional status, and 6-minute walking distance [6MWD]), and QOL were measured before surgery and at one, three, six, and 12 months after surgery. Data were analyzed using the χ² test, Fisher’s exact test, Mann-Whitney U test, t-test, and generalized estimation equations (GEE).

Results:

There were significant differences between the two groups regarding SEE (χ²=13.53, p=.009), PA (χ²=9.51, p=.049), functional status (χ²=10.55, p=.032), and 6MWD (χ²=15.62, p=.004). Although there were no time or group effects, the QOL mental component (Z=-2.78, p=.005) of the IG was higher than that of the CG one month after surgery. Interventions did not affect dyspnea or the QOL physical component.

Conclusion

The intervention of this study was effective in improving SEE, PA, functional status, and 6MWD of lung cancer patients after lung resection. Further extended investigations that utilize ETPB are warranted to confirm these results.

Keywords: Lung Neoplasms, Walking, Self Efficacy, Quality of Life

REFERENCES

1. National Cancer InformationCenter. Cancer facts and figures 2016 [Internet]. Goyang: National Cancer Information Center; 2018 [cited. 2019; Jan10]. Available from: https://. http://www.cancer.go.kr/lay1/bbs/S1T674C680/B/26/view.do?ar-ticle_seq=21129&cpage=2&rows=12&condition=&key.

2. National Collaborating Centre for Cancer. The diagnosis and treatment of lung cancer (update). NICE clinical guideline No. 121 [Internet]. Cardiff: National Collaborating Centre for Cancer (UK);2011. [cited 2018 Apr 5]. Available from:. https://www.ncbi.nlm.nih.gov/books/NBK99021/.

3. Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: Randomised controlled trial. Lung Cancer. 2011; 71(2):229–234. https://doi.org/10.1016/j.lungcan.2010.04.025.

4. Oksholm T, Rustoen T, Cooper B, Paul SM, Solberg S, Henriksen K, et al. Trajectories of symptom occurrence and severity from before through five months after lung cancer surgery. Journal of Pain and Symptom Management. 2015; 49(6):995–1015. https://doi.org/10.1016/j.jpainsymman.2014.11.297.

5. Feinstein MB, Krebs P, Coups EJ, Park BJ, Steingart RM, Burkhalter J, et al. Current dyspnea among long-term survivors of early-stage non-small cell lung cancer. Journal of Thoracic Oncology. 2010; 5(8):1221–1226. https://doi.org/10.1097/JTO.0b013e3181df61c8.

6. Rauma V, Sintonen H, Räsänen JV, Salo JA, Ilonen IK. Longterm lung cancer survivors have permanently decreased quality of life after surgery. Clinical Lung Cancer. 2015; 16(1):40–45. https://doi.org/10.1016/j.cllc.2014.08.004.

7. Möller A, Sartipy U. Associations between changes in quality of life and survival after lung cancer surgery. Journal of Thoracic Oncology. 2012; 7(1):183–187. https://doi.org/10.1097/JTO.0b013e3182340abb.

8. Granger CL, McDonald CF, Irving L, Clark RA, Gough K, Murnane A, et al. Low physical activity levels and functional decline in individuals with lung cancer. Lung Cancer. 2014; 83(2):292–299. https://doi.org/10.1016/j.lungcan.2013.11.014.

9. Lin YY, Wu YC, Rau KM, Lin CC. Effects of physical activity on the quality of life in taiwanese lung cancer patients receiving active treatment or off treatment. Cancer Nursing. 2013; 36(4):E35–E41. https://doi.org/10.1097/NCC.0b013e31826fb8bf.

10. World Health Organization (WHO). Global recommendations on physical activity for health [Internet]. Geneva: WHO Press;2010. [cited 2018 Apr 10]. Available from:. https://apps.who.int/iris/bitstream/handle/10665/44399/9789241599979_eng.pdf;jsessionid=22F5A8D00EA0AA9506149CEDBA1ED-57C?sequence=1.

11. Schmitz KH, Courneya KS, Matthews C, Demark-Wahne-fried W, Galvão DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise. 2010; 42(7):1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112.

12. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer Treatment Reviews. 2017; 52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010.

13. Ni HJ, Pudasaini B, Yuan XT, Li HF, Shi L, Yuan P. Exercise training for patients pre- and postsurgically treated for nonsmall cell lung cancer: A systematic review and meta-analysis. Integrative Cancer Therapies. 2017; 16(1):63–73. https://doi.org/10.1177/1534735416645180.

14. Reeve JC, Nicol K, Stiller K, McPherson KM, Birch P, Gordon IR, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. European Journal of Cardio-Thoracic Surgery. 2010; 37(5):1158–1166. https://doi.org/10.1016/j.ejcts.2009.12.011.

15. Bradley A, Marshall A, Stonehewer L, Reaper L, Parker K, Bevan-Smith E, et al. Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. European Journal of Cardio-Thoracic Surgery. 2013; 44(4):e266–e271. https://doi.org/10.1093/ejcts/ezt381.

16. Granger CL, Chao C, McDonald CF, Berney S, Denehy L. Safety and feasibility of an exercise intervention for patients following lung resection: A pilot randomized controlled trial. Integrative Cancer Therapies. 2012; 12(3):213–224. https://doi.org/10.1177/1534735412450461.

17. Lin YY, Liu MF, Tzeng JI, Lin CC. Effects of walking on quality of life among lung cancer patients: A longitudinal study. Cancer Nursing. 2015; 38(4):253–259. https://doi.org/10.1097/NCC.0000000000000176.

18. Ajzen I. Perceived behavioral control, self‐efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology. 2002; 32(4):665–683. https://doi.org/10.1111/j.1559-1816.2002.tb00236.x.

19. Rajati F, Sadeghi M, Feizi A, Sharifirad G, Hasandokht T, Mostafavi F. Self-efficacy strategies to improve exercise in patients with heart failure: A systematic review. ARYA Atherosclerosis. 2014; 10(6):319–333.

20. Hong YL. Effect of preoperative educational DVD on postoperative self care knowledge and performance in lung cancer patient [master’s thesis]. Seoul: Hanyang University;2007. p. 1–33.

21. Sniehotta FF, Scholz U, Schwarzer R. Action plans and coping plans for physical exercise: A longitudinal intervention study in cardiac rehabilitation. British Journal of Health Psychology. 2006; 11(1):23–37. https://doi.org/10.1348/135910705X43804.

22. Darker CD, French DP, Eves FF, Sniehotta FF. An intervention to promote walking amongst the general population based on an ‘extended’ theory of planned behaviour: A waiting list randomised controlled trial. Psychology and Health. 2010; 25(1):71–88. https://doi.org/10.1080/08870440902893716.

23. Pfeffer I, Strobach T. Effects of a planning intervention on physical activity behavior in an RCT: Intention strength as moderator and action planning, coping planning, and coping self-efficacy as mediators. Sport, Exercise, and Performance Psychology. 2018; 8(2):192–209. https://doi.org/10.1037/spy0000137.

24. Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, et al. Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: A systematic review. British Journal of Cancer. 2014; 110(4):831–841. https://doi.org/10.1038/bjc.2013.750.

25. Kim I, Lee H. Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection. Journal of Korean Academy of Nursing. 2014; 44(4):381–390. https://doi.org/10.4040/jkan.2014.44.4.381.

26. Conde MV, Adams SG. Overview of the management of postoperative pulmonary complications [Internet]. Waltham (MA): UpToDate;2018. [cited 2018 Oct 30]. Available from:. https://www.uptodate.com/contents/overview-of-the-management-of-postoperative-pulmonary-complications?-search=postoperative%20complications&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.

27. Varela G, Novoa NM, Agostini P, Ballesteros E. Chest physiotherapy in lung resection patients: State of the art. Seminars in Thoracic and Cardiovascular Surgery. 2011; 23(4):297–306. https://doi.org/10.1053/j.semtcvs.2011.11.001.

28. Stigt JA, Uil SM, van Riesen SJ, Simons FJ, Denekamp M, Shahin GM, et al. A randomized controlled trial of postthora-cotomy pulmonary rehabilitation in patients with resectable lung cancer. Journal of Thoracic Oncology. 2013; 8(2):214–221. https://doi.org/10.1097/JTO.0b013e318279d52a.

29. Bandura A. Guide for creating self-efficacy scales. Urdan T, Pajares F, editors. Self-Efficacy Beliefs of Adolescents. Greenwich (CT): Information Age Publishing;2006. p. 307–337.

30. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise. 2003; 35(8):1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB.

31. Oh JY, Yang YJ, Kim BS, Kang JH. Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form. Journal of the Korean Academy of Family Medicine. 2007; 28(7):532–541.

32. Eakin EG, Resnikoff PM, Prewitt LM, Ries AL, Kaplan RM. Validation of a new dyspnea measure: The UCSD shortness of breath questionnaire. University of California, San Diego. Chest. 1998; 113(3):619–624. https://doi.org/10.1378/chest.113.3.619.

33. Sung JD, On YK, Kim HS, Chae IH, Sohn DW, Oh BH, et al. Development of Korean activity scale/index (KASI). Korean Circulation Journal. 2000; 30(8):1004–1009. https://doi.org/10.4070/kcj.2000.30.8.1004.

34. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine. 2002; 166(1):111–117. https://doi.org/10.1164/ajrccm.166.1.at1102.

35. Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996; 34(3):220–233. https://doi.org/10.1097/00005650-199603000-00003.

36. Hardin JW, Hilbe JM. Generalized estimating equations. 2nd ed. Boca Raton (FL): CRC Press;2012. p. 59–156.

37. Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention-behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychology and Health. 2005; 20(2):143–160. https://doi.org/10.1080/08870440512331317670.

38. Cavalheri V, Tahirah F, Nonoyama M, Jenkins S, Hill K. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2013; (7). CD009955. https://doi.org/10.1002/14651858.CD009955.pub2.

39. Sniehotta FF, Schwarzer R, Scholz U, Schüz B. Action planning and coping planning for long‐term lifestyle change: Theory and assessment. European Journal of Social Psychology. 2005; 35(4):565–576. https://doi.org/10.1002/ejsp.258.

40. Selzler AM, Rodgers WM, Berry TR, Stickland MK. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabilitation Psychology. 2016; 61(4):380–388. https://doi.org/10.1037/rep0000106.

41. Lin S, Chen Y, Yang L, Zhou J. Pain, fatigue, disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients. Journal of Clinical Nursing. 2013; 22(9-10):1281–1290. https://doi.org/10.1111/jocn.12228.

42. Hyland ME. A brief guide to the selection of quality of life instrument. Health and Quality of Life Outcomes. 2003; 1:24. https://doi.org/10.1186/1477-7525-1-24.

43. Sebio Garcia R, Yáñez Brage MI, Giménez Moolhuyzen E, Granger CL, Denehy L. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: A systematic review and meta-analysis. Interactive Cardiovascular and Thoracic Surgery. 2016; 23(3):486–497. https://doi.org/10.1093/icvts/ivw152.

44. Morrison EJ, Novotny PJ, Sloan JA, Yang P, Patten CA, Ruddy KJ, et al. Emotional problems, quality of life, and symptom burden in patients with lung cancer. Clinical Lung Cancer. 2017; 18(5):497–503. https://doi.org/10.1016/j.cllc.2017.02.008.

Figure 1.

Flow chart of this study.

Figure 2.

Conceptual framework of this study.

Table 1.

Extended Theory of Planned Behavior-based Nursing Intervention

	Education	Goal setting (action & coping plan)	Feedback
Contents	• Importance of exercise (walking &	Goal setting for exercise:	• Checking goal & achievement level
	shoulder exercise)	• Progressive walking
	• Pedometer usage	- Start: 1000 steps, increasing 1000 steps every day for 5 days then increase 1000 steps every 3	• Defining difficulties during exercise
	• Importance of deep breathing/ coughing & its methods	days, if possible - Goal: 10,000 steps/day	• Question: “Do you think exercise can help you recover your health?”
	• Sleep/nutritional intake/ management of body weight/	• Shoulder exercise/Deep breathing & coughing: - Start: 1 set (5 times/set) on bed - Increasing 1 set by every day	• Providing positive feedback when achieving goals
	smoking cessation	- Maximum: 8 set/day
	• Aggravated symptoms that need additional hospital visits	Action plan: • When, where, how, how often?
		• Simple, clear, & individualized plan
		• Set own goals
		Coping plan:
		• Check barriers when conducting action plan
		• Counselor and participants collaboratively develop
		coping strategy to overcome barriers
Methods	Booklet/Exercise diary/Pedometer Pedometer/Exercise diary
Frequency	Once (the day before surgery) Surgery~POD 5: everyday
		POD 6~<1 month: twice/week
		1~<3 months: twice/month
		3~<6 months: once/month
		6~12 months: once/2 months
Duration (min)	10~15	5~10
Mode	Face-to-face	In hospital: face-to-face/After discharge: telephone
Strategies	IBC	IBC, PBC (SE), AP, CP

IBC=Intention for behavior change; PBC=Perceived behavioral control; SE=Self-efficacy; AP=Action plan; CP=Coping plan.

Table 2.

General and Disease Related Characteristics of the Partic pants (N=87

Characteristics	Int. (n=51)	Comp. (n=36)	χ²/t	p
Characteristics	M±SD/n (%)	M±SD/n (%	χ²/t	p
Age (yr)	65.3±8.73	64.0±7.61	-0.71	.482
40~49	3 (5.9)	1 (2.8)	1.54	.673
50~59	11 (21.6)	6 (16.7)
60~69	18 (35.3)	17 (47.2)
≥65	19 (37.2)	12 (33.3)
Gender			0.02	>.999
Man	32 (62.7)	22 (61.1)
Woman	19 (37.3)	14 (38.9)
Spouse			0.20	.688
No	3 (5.9)	3 (8.3)
Yes	48 (94.1)	33 (91.7)
Education			0.12	.829
Below middle school	26 (51.0)	17 (47.2)
Over high school	25 (49.0)	19 (52.8)
Employment			0.74	.482
No	37 (72.5)	23 (63.9)
Yes	14 (27.5)	13 (36.1)
Total monthly income			4.10	.250
(10,000 won)
<100	27 (52.9)	16 (44.4)
100～299	12 (23.5)	14 (38.9)
300～499	8 (15.7)	2 (5.6)
≥500	4 (7.9)	4 (11.1)
Regular exercise			0.06	.831
No	27 (52.9)	20 (55.6)
Yes	24 (47.1)	16 (44.4)
Smoking history			0.57	.751
Never	30 (58.8)	20 (55.6)
Ex-smoker	15 (29.4)	13 (36.1)
Current smoker	6 (11.8)	3 (8.3)
BMI	23.67±2.68	23.83±2.65	0.27	.787
<18.0	2 (3.9)	0 (0.0)	3.04	.219
18.0~24.9	35 (68.6)	21 (58.3)
≥25	14 (27.5)	15 (41.7)
Comorbidity
COPD	1 (2.0)	2 (5.6)	0.82^†	.567
Hypertension	15 (29.4)	12 (33.3)	0.15	.815
Diabetes mellitus	8 (15.7)	3 (8.3)	1.03	.351
Heart disease	2 (3.9)	3 (8.3)	0.76	.645
Type of surgical			0.30	.859
resection
Wedge resection	4 (7.8)	4 (11.1)
Segmentectomy	5 (9.8)	3 (8.3)
Lobectomy	42 (82.4)	29 (80.6)
Preoperative FEV₁	86.59±17.56	83.17±14.05	5 -0.97	.335
(% predicted)
≤60	3 (5.9)	1(2.8)	0.46	.639
>60	48 (94.1)	35 (97.2)
Int.=Intervention group; Comp.=Comparison group; BMI=Bod Index; COPD=Chronic Obstructive Pulmonary Disease; FEV₁= Expiratory Volume in 1 second. ^†Fisher’s exact test.				dy Mas =Force

Table 3.

Effects of the Intervention on Self-Efficacy for Exercise, Physical Activity, Physical Function, and Quality of Life (N=87)

Variaable	Group	T1 (Int.=51; Comp.=36) M±SD/Median [IQR]		T2 (Int.=37; Comp.=28) M±SD/Median [IQR]		T3 (Int.=35; Comp.=26) M±SD/Median [IQR]		T4 (Int.=30; Comp.=25) M±SD/Median [IQR]		T5 (Int.=29; Comp.=25) M±SD/Median [IQR]		Source	χ²	p
Variaable	Group	t/Z	p	t/Z	p	t/Z	p	t/Z	p	t/Z	p	Source	χ²	p
Self-efficacy for exercise	Int. Comp.	47.00 [36.00]	53.51±17.23	57.00 [49.00]	62.20±4.72	70.00[37.50]	Group	8.04	.005
		45.00 [33.50]	52.43±20.80	51.50 [30.50]	41.44±4.09	45.00[21.00]	Time	17.24	.002
		-0.42^†	.672	-0.23	.819	-0.90^†	.368	-3.26	.002	-3.49^†	<.001	G*T	13.53	.009
Physical activity	Int. Comp.	594.00[742.50]	1188.00 [1596.00]	1980.00 [1881.00]	1399.50 [1798.50]	1386.00[1852.75]	Group	2.61	.106
726.00 [1157.25]	519.75 [462.00]	928.50 [2314.13]	1386.00 [1039.88]	462.00[977.63]	Time	18.94	.001
-1.15^†	.249	-3.82^†	<.001	-1.30^†	.194	-1.53^†	.125	-2.69^†	.007	G*T	9.51	.049
Physical function Dyspnea
Int. Comp.	2.00 [5.00]	6.00 [6.00]	5.00 [16.00]	3.50 [10.00]	2.00[6.00]	Group	0.40	.528
		1.00 [8.00]	12.50 [25.50]	5.50 [7.00]	2.00 [5.50]	3.00[9.00]	Time	29.42	<.001
		-0.25^†	.803	-1.87^†	.062	-0.62^†	.539	-0.98^†	.327	-1.28^†	.200	G*T	7.34	.119
Functional status	Int. Comp.	72.00 [33.00]	39.00 [30.25]	49.55±3.42	54.66±3.47	52.00 [30.00]	Group	2.47	.116
		68.50 [37.13]	33.25 [12.65]	46.77±3.68	52.76±3.92	52.00[30.75]	Time	91.26	<.001
		-0.12^†	.905	-2.58^†	.010	-0.55	.586	-0.36	.718	-1.34^†	.179	G*T	10.55	.032
6MWD	Int. Comp.	390.00 [80.00]	405.53±81.85	448.05±14.79	489.35±20.52	480.04	4±20.97	Group	11.61	.001
		378.30 [127.95]	373.84±76.83	368.87±21.35	377.77±16.64	407.31	1±22.89	Time	25.20	<.001
		-0.02^†	.982	-1.56	.124	-3.15	.003	-4.11	<.001	-2.35	.023	G*T	15.62	.004
Quality of life
PCS	Int. Comp.	46.16 [13.70]	43.82±7.03	48.57 [12.15]	48.44 [8.31]	46.47[11.36]	Group	1.58	.209
		45.70 [1	7.76]	40.71±5.60	45.23 [11.78]	47.59 [10.20]	43.44	[7.84]	Time	13.04	.011
		-0.89^†	.375	-1.93	.058	-0.55^†	.584	-0.58^†	.559	-0.82^†	.410	G*T	1.38	.848
MCS	Int. Comp.	47.34±10.05	53.05 [17.50]	50.36 [15.81]	52.60 [19.92]	52.34[18.41]	Group	1.00	.317
		47.42±11.78	38.92 [15.14]	50.62 [20.58]	48.12 [22.58]	56.17[19.60]	Time	5.17	.270
		0.04	.972	-2.78^†	.005	-0.68^†	.498	-0.47^†	.642	-0.25^†	.801	G*T	7.25	.123

T1 (baseline), T2 (1 mo), T3 (3 mo), T4 (6 mo), T5 (12 mo). Int.=Intervention group; Comp.=Comparison group; IQR=InterQuartile Range; 6MWD=6 Minute walking distance; PCS=Physical Components Score of quality of life; MCS=Mental Components Score of quality of life.

^† Mann-Whitney U test.

TOOLS

Similar articles