BackgroundThe new Corona-Virus disease (COVID-19) can result in a large variety of chronic health issues like impaired lung function, reduced exercise performance, and diminished quality of life. Our study aimed to investigate the efficacy, feasibility, and safety of pulmonary rehabilitation (PR) in COVID-19 patients and to compare outcomes between patients with a mild/moderate and a severe/critical course of the disease.MethodsPatients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive three-week inpatient PR were included in this prospective, observational cohort study. Several measures of exercise performance (6-minute walk distance, 6MWD), lung function (forced vital capacity, FVC), and quality of life (36 question short-form health survey, SF-36) were assessed before and after PR.ResultsFifty patients were included in the study (24 with mild/moderate and 26 with severe/critical COVID-19). On admission, patients had a reduced 6MWD (mild: 509 m [426–539]; severe: 344 m [244–392]), an impaired FVC (mild: 80% [59–91]; severe: 75% [60–91]) and a low SF-36 mental health score (mild: 49 pts [37–54]; severe: 39 pts [30–53]). Patients attended a median of 100% [94–100] of all provided PR sessions. At discharge, patients in both subgroups improved in 6MWD (mild/moderate: +48 m [35–113 m]; severe/critical: +124 m [75–145 m], both p<0.001), FVC (mild/moderate: +7.7% [1.0–17.8], p=0.002; severe/critical: +11.3% [1.0–16.9], p<0.001) and SF-36 mental component (mild/moderate +5.6 pts [1.4–9.2], p=0.071; severe/critical: +14.4 pts [−0.6–24.5], p<0.001). No adverse event was observed.ConclusionOur study shows that PR is a feasible, safe, and effective therapeutic option in COVID-19 patients independent of disease severity.

In chronic obstructive pulmonary disease, impairments of dyadic coping are associated with reduced quality of life. However, existing studies have a cross-sectional design. The present study explores changes in dyadic coping over time and its long-term effects on quality of life of both patients suffering from COPD and their partners. Dyadic coping, psychological distress, health-related quality of life, and exercise capacity were assessed in 63 patients suffering from COPD with their partners, at baseline and 3-year-follow-up. Correlation analyses and actor-partner interdependence models (APIMs) were conducted. Patients' delegated dyadic coping (taking over tasks) and common dyadic coping (mutual coping efforts when both partners are stressed) rated by the spouses decreased. Correlation analyses showed that patients' quality of life at follow-up was positively influenced by partners' stress communication (signaling stress). Partners' quality of life at follow-up was negatively influenced by patients' negative dyadic coping (reacting superficially, ambivalently or hostilely) and positively influenced by partners' delegated dyadic coping rated by patients (taking over tasks). APIMs mostly supported these results. It seems important that both partners communicate about stress and provide appropriate instrumental and emotional support to maintain quality of life.

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPDrelated fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Many studies have investigated the highly relevant association between pain and disability in clinical groups using the Pain Disability Index (PDI). To interpret these results, knowledge of disability in the general population is crucial. Moreover, to investigate criterion validity of the PDI, the influence on health care utilisation (HCU) is of special interest. In the present study, a broadened version of the PDI was psychometrically evaluated with a large representative sample of the general population. The independent impact of disability on HCU was also investigated. A representative sample of the German general population (N=2510) was screened for disability, somatic complaints, mental health (PHQ) and HCU. Following a psychometric evaluation of the PDI, data are provided about the distribution of disability in the general population. For the prediction of HCU, stepwise linear regression analysis was calculated. The psychometric evaluation of the PDI revealed a one-factor solution, high reliability, and satisfactory construct validity. Percentage scores for the distribution of disability are provided for those people reporting at least one pain/somatic symptom. These data allow a better description of disability in clinical samples. Somatic complaints, disability, unemployment or retirement, depression and anxiety explained 26% of the variance for HCU. The PDI is an economical, reliable and valid self-rating instrument for assessing disability caused by physical symptoms. HCU in the general population is determined by the number and severity of somatic complaints and also by disability. Symptoms and disability play a crucial but somewhat independent role.

No abstract