ArticlePatient preference and adherence2026
Effectiveness of an Internet-Based 4C Nursing Model on Pulmonary Rehabilitation Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Quasi-Experimental Study.
Article in Patient preference and adherence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: 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. Patients and Methods: 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. Results: 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). Conclusion: 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.
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