Abstract：
OBJECTIVE: To develop and validate an evidence-based home pursed lip breathing (PLB) intervention protocol for improving related health outcomes (e.g., dyspnea and exercise capability) in patients with chronic obstructive pulmonary disease (COPD) and to present a detailed intervention development process.
METHODS: This home PLB intervention protocol employed phase one of the Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions to guide the development process of the PLB intervention. We searched for research evidence on 5 July 2023 from several databases, including PubMed, Embase (via Ovid), Cochrane Library, Google Scholar and China Biology Medicine Disk (CBM). Using the content validity index, a panel of experts assessed the appropriateness of the PLB protocol.
RESULTS: We developed the preliminary home PLB intervention protocol on the basis of several underlying rationales, which encompass the extension of expiration time, enhancement of respiratory muscle strength, augmentation of tidal volume and integration of the most reliable research evidence obtained from four systematic reviews, five RCTs, five clinical trials, and 10 recommendations. We structured the PLB intervention with a designated time ratio of inspiration to expiration, set at 1:2. Additionally, this study recommends that the training parameters of the PLB intervention were as follows: three sessions per day, each lasting for 10 min, over 8 weeks. Individualised PLB training intensity adjusted the inhalation component according to each participant\'s tolerance level while emphasising the exhalation phase to ensure the complete expulsion of air from the lungs. The home PLB intervention protocol established strong content validity through consensus, which was reached among all panel experts. The item-level and scale-level content validity indices (CVIs) reached a maximum score of 1.0, indicating a high level of agreement and credibility in the protocol\'s content as evaluated by the expert panel.
CONCLUSIONS: An optimal evidence-based home PLB protocol has been adapted and developed to manage health-related outcomes of patients with COPD. The protocol is transparent and fully supported by relevant mechanisms, concrete evidence, recommendations and experts\' consensus.
CONCLUSIONS: In this study, we consulted patients with COPD about the \'Prepared Conditions Before PLB Practice\', to ensure appropriate measures to prevent patients with COPD from potential risks. In addition, patients with COPD also contributed to the PLB exercise frequency distribution.
METHODS: This home PLB intervention protocol employed phase one of the Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions to guide the development process of the PLB intervention. We searched for research evidence on 5 July 2023 from several databases, including PubMed, Embase (via Ovid), Cochrane Library, Google Scholar and China Biology Medicine Disk (CBM). Using the content validity index, a panel of experts assessed the appropriateness of the PLB protocol.
RESULTS: We developed the preliminary home PLB intervention protocol on the basis of several underlying rationales, which encompass the extension of expiration time, enhancement of respiratory muscle strength, augmentation of tidal volume and integration of the most reliable research evidence obtained from four systematic reviews, five RCTs, five clinical trials, and 10 recommendations. We structured the PLB intervention with a designated time ratio of inspiration to expiration, set at 1:2. Additionally, this study recommends that the training parameters of the PLB intervention were as follows: three sessions per day, each lasting for 10 min, over 8 weeks. Individualised PLB training intensity adjusted the inhalation component according to each participant\'s tolerance level while emphasising the exhalation phase to ensure the complete expulsion of air from the lungs. The home PLB intervention protocol established strong content validity through consensus, which was reached among all panel experts. The item-level and scale-level content validity indices (CVIs) reached a maximum score of 1.0, indicating a high level of agreement and credibility in the protocol\'s content as evaluated by the expert panel.
CONCLUSIONS: An optimal evidence-based home PLB protocol has been adapted and developed to manage health-related outcomes of patients with COPD. The protocol is transparent and fully supported by relevant mechanisms, concrete evidence, recommendations and experts\' consensus.
CONCLUSIONS: In this study, we consulted patients with COPD about the \'Prepared Conditions Before PLB Practice\', to ensure appropriate measures to prevent patients with COPD from potential risks. In addition, patients with COPD also contributed to the PLB exercise frequency distribution.
摘要：
目的：开发和验证基于证据的家庭唇呼吸（PLB）干预方案，以改善相关的健康结果（例如，呼吸困难和运动能力）在慢性阻塞性肺疾病（COPD）患者中，并提出了详细的干预发展过程。
方法：本家庭PLB干预方案采用了医学研究理事会（MRC）开发和评估复杂干预措施框架的第一阶段，以指导PLB干预措施的开发过程。我们在2023年7月5日从几个数据库中搜索了研究证据，包括PubMed,Embase（通过Ovid），科克伦图书馆,谷歌学者和中国生物医学杂志(CBM)。使用内容有效性指数，一个专家小组评估了PLB方案的适当性.
结果：我们在几个基本原则的基础上制定了初步的家庭PLB干预方案，包括延长到期时间，增强呼吸肌的力量，增加潮气量和整合从四个系统评价中获得的最可靠的研究证据，五个RCT,五项临床试验,十项建议。我们用指定的吸气和呼气时间比率构建了公共小巴干预措施，设置在1:2。此外,这项研究建议PLB干预的训练参数如下：每天三次，每次持续10分钟，超过8周。个性化的PLB训练强度根据每个参与者的耐受水平调整吸入成分，同时强调呼气阶段，以确保空气从肺部完全排出。家庭小巴干预协议通过共识建立了强大的内容有效性，所有小组专家都达成了这一共识。项目级别和规模级别的内容有效性指数（CVI）达到了1.0的最高得分，表明专家小组评估的协议内容具有很高的一致性和可信度。
结论：已经调整并开发了基于证据的最佳家庭PLB方案，以管理COPD患者的健康相关结局。议定书是透明的,得到有关机制的充分支持,具体证据,建议和专家共识。
结论：在这项研究中，我们咨询了COPD患者关于“PLB实践前的准备条件”，确保采取适当措施防止COPD患者发生潜在风险。此外,COPD患者也参与了PLB运动频率的分布.
方法：本家庭PLB干预方案采用了医学研究理事会（MRC）开发和评估复杂干预措施框架的第一阶段，以指导PLB干预措施的开发过程。我们在2023年7月5日从几个数据库中搜索了研究证据，包括PubMed,Embase（通过Ovid），科克伦图书馆,谷歌学者和中国生物医学杂志(CBM)。使用内容有效性指数，一个专家小组评估了PLB方案的适当性.
结果：我们在几个基本原则的基础上制定了初步的家庭PLB干预方案，包括延长到期时间，增强呼吸肌的力量，增加潮气量和整合从四个系统评价中获得的最可靠的研究证据，五个RCT,五项临床试验,十项建议。我们用指定的吸气和呼气时间比率构建了公共小巴干预措施，设置在1:2。此外,这项研究建议PLB干预的训练参数如下：每天三次，每次持续10分钟，超过8周。个性化的PLB训练强度根据每个参与者的耐受水平调整吸入成分，同时强调呼气阶段，以确保空气从肺部完全排出。家庭小巴干预协议通过共识建立了强大的内容有效性，所有小组专家都达成了这一共识。项目级别和规模级别的内容有效性指数（CVI）达到了1.0的最高得分，表明专家小组评估的协议内容具有很高的一致性和可信度。
结论：已经调整并开发了基于证据的最佳家庭PLB方案，以管理COPD患者的健康相关结局。议定书是透明的,得到有关机制的充分支持,具体证据,建议和专家共识。
结论：在这项研究中，我们咨询了COPD患者关于“PLB实践前的准备条件”，确保采取适当措施防止COPD患者发生潜在风险。此外,COPD患者也参与了PLB运动频率的分布.
