The Effect of Pursed Lip Breathing Exercise and Laughter Therapy Individuals With The COPD

This research is a single-blind, randomized controlled experimental study in order to determine the effect of pursed lip breathing exercise and laughter therapy on dyspnea severity, health status and care dependence in individuals with COPD. Research hypotheses H0-1: Pursed lip breathing exercise has no effect on the severity of dyspnea in individuals with COPD. H0-2: Laughter therapy has no effect on the severity of dyspnea in individuals with COPD. H0-3: Pursed lip breathing exercise has no effect on health status in individuals with COPD. H0-4: Laughter therapy has no effect on health status in individuals with COPD. H0-5: Pursed lip breathing exercise has no effect on care dependence in individuals with COPD. H0-6: Laughter therapy has no effect on care dependence in individuals with COPD. Population: COPD patients receiving service in Ankara City Hospital Chest Diseases polyclinics and clinics constitute the population of the research. Sample: Since there is no study in the literature examining the effects of pursed lip breathing exercise and laughter therapy in COPD patients, El-saidy et al. (2019) based on the study data, a sample calculation was made; Dyspnea 12 Scale scores before and after pursed lip breathing exercise (31.05± 9.2 and 22.31 ± 7.76, respectively) were found to be statistically significant (p \< 0.001) (66). The effect size was calculated as 1.026 using the Priori method and the G Power program, and a total of 63 patients, at least 21 for each group, should be included in the study with a confidence interval of 95% and a power of 90%. Research Group The patients in the institution where the study was conducted were evaluated for eligibility for the study. Voluntary consent is obtained by giving information about the research. In the study, stratified randomization method is used to ensure homogeneity between groups. Using the randomization program (https://www.randomizer.org); Stratified according to COPD Assessment Test (CAT) score (10≤ CAT≤ 25 and 25≤ CAT≤ 40) and smoking status (smoker and non-smoker); Patient lists were created as pursed lip breathing exercise intervention group, laughter therapy intervention group and control group Research Group The patients in the institution where the study was conducted were evaluated for eligibility for the study. Voluntary consent is obtained by giving information about the research. In the study, stratified randomization method is used to ensure homogeneity between groups. Using the randomization program (https://www.randomizer.org); Stratified according to COPD Assessment Test (CAT) score (10≤ CAT≤ 25 and 25≤ CAT≤ 40) and smoking status (smoker and non-smoker); Patient lists were created as pursed lip breathing exercise intervention group, laughter therapy intervention group and control group. The evaluation of the eligibility of the patients in the institution where the research was carried out, in line with the criteria of inclusion and exclusion from the research, is made by the thesis student. After the patient was informed about the study and their voluntary consent was obtained, the "Patient Information Form" was filled by the thesis student and according to the patient lists obtained through the https://www.randomizer.org program and stratified randomization, the patients were pursed lip breathing exercise intervention group, laughter therapy intervention group. and assigned to control groups. Intervention Groups Intervention Group (A): During the first interview, the training and demonstration of pursed lip breathing exercise is performed by the thesis student in a single session, lasting approximately 40 minutes. The effects of pursed lip breathing exercise on health and its application steps are explained to the patient, and purse lip breathing exercise is performed together with the patient. In addition, the training is reinforced by giving a pursed lip breathing exercise brochure to the patient and sending a pursed lip breathing exercise application video prepared by the thesis student via whatsapp. Patients who do not have Whatsapp application are sent a video to one of their family members. After this information session, the pursed lip breathing exercise taught from the patients; They are asked to do it in their own homes, 3 days a week on Monday, Wednesday and Friday, for about 30 minutes each session, for a total of eight weeks. In order to support patients' compliance with the research; During the application process, on Mondays, Wednesdays and Fridays, the patient was contacted by the thesis student at a predetermined time, and the situation of performing pursed lip breathing exercise was questioned and recorded in the control chart . In addition, one day a week (on a day determined by the patient, Monday, Wednesday or Friday), the thesis student makes a video call to the patient on WhatsApp, and the practice of pursed lip breathing exercise is performed during the video call. After the end of the eighth week, the patients are asked to take a break from the pursed lip breathing exercise for 4 weeks (weeks 9-12), and no application is made during this period. Intervention Group (B) During the first interview, laughter therapy training and demonstration is carried out by the thesis student in a single session, lasting approximately 50 minutes. The effects of laughter therapy on health and its application steps are explained to the patient, and the laughter therapy practice is carried out together with the patient. In addition, the training is reinforced by giving a laughter therapy training brochure to the patient and sending the laughter therapy application video prepared by the thesis student via whatsapp. Patients who do not have Whatsapp application are sent a video to one of their family members. After this information session, the laughter therapy taught from the patients; They are asked to do this in their own homes, 3 days a week on Monday, Wednesday and Friday, 30 minutes each session, for a total of eight weeks. In order to support patients' compliance with the research; During the application process, on Mondays, Wednesdays and Fridays, the patient is contacted by the thesis student at a predetermined time, and their status of doing laughter therapy is questioned and recorded in the laughter therapy application control chart. In addition, once a week (on a day determined by the patient, Monday, Wednesday or Friday), the thesis student makes a video call to the patient on WhatsApp, and laughter therapy is practiced during the video call. After the end of the eighth week, the patients are asked to take a break from the laughter therapy for 4 weeks (weeks 9-12), and no application is made during this period. Control Group(C) Attention-match training is given to the patients in the control group. During the first interview, attention matching training is carried out by the thesis student for one time, about "Lung structure and functioning", lasting approximately 20 minutes. In addition, a brochure about lung structure and functioning is given to patients. The patients in the control group are not subjected to any other interventions throughout the study. Data Collection The evaluation of the eligibility of the patients in the institution where the research was carried out, in line with the criteria of inclusion and exclusion from the research, is made by the thesis student. After the patient was informed about the study and their voluntary consent was obtained, the "Patient Information Form" was filled by the thesis student and according to the patient lists obtained through the https://www.randomizer.org program and stratified randomization, the patients were pursed lip breathing exercise intervention group, laughter therapy intervention group. and assigned to control groups. The scales used in the research are filled by an independent interviewer. In order to provide blinding during the data collection phase of the study, the information about which groups the patients belong to is hidden from the interviewer. In addition, patients are told not to share the information of which group they belong to during the data collection process. Dyspnea-12 Scale, COPD Assessment Test and Care Dependence Scale 1.,2. all patients in the intervention and control groups; On the first interview day, they are told to take a break from the 4th, 8th and pursed lip breathing exercise and laughter therapy programs for 4 weeks, and they are applied again in the 12th week. The scales are filled by an independent interviewer by telephone after the completion of pursed lip breathing exercise and laughter therapy on Friday of the 4th, 8th and 12th weeks. The interviewer was given a training that included the structure, application and purpose of the scale by the thesis student.