Effectiveness of an Internet-Based 4C Nursing Model on Pulmonary Rehabilitation Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Quasi-Experimental Study.

Authors

Fufen Shen, Zhankun Guo, Zhifen Zhang, Hui Zhou

Published in

Patient preference and adherence. Volume 20. Pages 609086. Epub Jun 30, 2026.

Abstract

Pulmonary rehabilitation (PR) adherence in patients with chronic obstructive pulmonary disease (COPD) declines markedly after hospital discharge, underscoring the need for theory-driven, continuous care models. The 4C nursing model-integrating Comprehensiveness, Collaboration, Coordination, and Continuity-provides a structured, patient-centered framework that may simultaneously address multiple adherence barriers when delivered via internet-based platforms. This study evaluated the effectiveness of this integrated approach for COPD pulmonary rehabilitation.
A quasi-experimental study was conducted at Baoding Rehabilitation Hospital (January-December 2024). Ninety-four patients with COPD (GOLD stages II-III) were allocated sequentially to a control group (n = 47; conventional nursing care) or an intervention group (n = 47; internet-based 4C nursing model). Primary outcomes were COPD knowledge scores and PR adherence; secondary outcomes included the COPD Self-Efficacy Scale (CSES), FEV1% predicted, and the COPD Assessment Test (CAT). Outcomes were assessed at baseline, 3 months, and 6 months.
Baseline characteristics were comparable between groups (all P > 0.05). At 6 months, the intervention group showed significantly greater improvements in COPD knowledge (mean difference 8.55; 95% CI 7.27-9.83; Cohen's d = 2.70), self-efficacy (mean difference 15.48; 95% CI 12.25-18.71; d = 1.94), and PR adherence (mean difference 0.74; 95% CI 0.50-0.97; d = 1.27), alongside significant improvements in FEV1% predicted (P = 0.005; d = 0.77) and CAT scores (P < 0.001; d = 1.39).
This single-center quasi-experimental study found that an internet-based 4C nursing model was associated with clinically meaningful improvements across multiple COPD outcomes over 6 months. These preliminary findings support the feasibility of theory-driven, telehealth-enhanced nursing care and warrant confirmation through multicenter randomized trials.

PMID:
42405288
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.