Impact of Nurse-Led Pulmonary Rehabilitation on Dyspnea, Fatigue and Self-Efficacy in COPD Patients

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition characterized by airflow limitation, dyspnea, and fatigue, significantly impairing quality of life. Globally, COPD is a leading cause of morbidity and mortality, with its burden disproportionately affecting low- and middle-income countries such as Pakistan, where healthcare resources are limited and structured rehabilitation programs are scarce. Despite evidence supporting pulmonary rehabilitation (PR) as an effective intervention for improving physical capacity, symptom control, and quality of life, its implementation in Pakistan remains minimal. Nurse-led PR programs, which integrate education, and exercise have demonstrated positive outcomes internationally; however, their feasibility and effectiveness in resource-limited settings are largely unexplored. This study aims to evaluate the effectiveness of a nurse-led pulmonary rehabilitation program on self-efficacy, dyspnea, and fatigue among COPD patients in Pakistan. The research will employ a randomized controlled trial (RCT) design, enrolling adults aged 40 years or older diagnosed with moderate to severe COPD. Participants will be randomly assigned to either an intervention group receiving a structured 12-week nurse-led PR program or a control group receiving routine care. The intervention will include weekly sessions focusing on disease education, breathing exercises and physical activity delivered through OPD visits and telephonic follow-ups. Each pulmonary rehabilitation session will last between 60 to 90 minutes, incorporating exercise training and educational components. Researcher will provide individualized guidance and monitor adherence through patient regular check-ins. Regular check-ins will occur bi-weekly and involve either a phone call or in-person meeting to discuss the patient's progress, answer any questions, and address concerns. During these sessions, the researcher will evaluate the patient's adherence to the program and provide further guidance or adjustments to the rehabilitation plan. Primary outcomes-self-efficacy, Dyspnea, and fatigue-will be assessed using validated tools: the COPD Self-Efficacy Scale (CSES), Modified Medical Research Council (mMRC) Dyspnea Scale, and Fatigue Severity Scale (FSS). The intervention will last 12 weeks, followed by post test. The 12-week duration of the pulmonary rehabilitation program is based on established evidence that suggests this period is sufficient for significant improvement in COPD symptoms, exercise capacity, and overall well-being. Studies have demonstrated that a 12-week program leads to reduced Dyspnea, improved physical fitness, and enhanced quality of life for patients with COPD. To evaluate the effectiveness of the pulmonary rehabilitation program on Dyspnea and fatigue status, Chi-square / Fisher's exact test will be used to compare the post-intervention results between the two groups. Independent sample t-test / Mann-Whitney test will be used to compare the self-efficacy score between the intervention and control groups. The anticipated results include reduced Dyspnea severity, alleviated fatigue and improved self-efficacy in the intervention group compared to controls. These findings will provide evidence for the feasibility and effectiveness of nurse-led PR programs in Pakistan, offering a cost-effective strategy to enhance COPD management in resource-limited settings. The study's outcomes have the potential to inform healthcare policy, promote integration of nurse-led interventions into chronic care models, and ultimately improve quality of life for COPD patients.