Psychological Changes During Pulmonary Rehabilitation and Target-Flow Inspiratory Muscle Training in COPD Patients With a Ventilatory Limitation During Exercise

274

161

Q Qu ua al li it ty y o of f l li if fe e i in n p pa at ti ie en nt ts s w wi it th h c ch hr ro on ni ic c o ob bs st tr ru uc ct ti iv ve e p pu ul lm mo on na ar ry y d di is se ea as se e i im mp pr ro ov ve es s a af ft te er r r re eh ha ab bi il li it ta at ti io on n a at t h ho om me e P.J. Wijkstra*, R. Van Altena*, J. Kraan* We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV 1 ) 1.3±0.4 l (mean±SD), FEV 1 /inspiratory vital capacity (IVC) 37±7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ).We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance.Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.

Section: Discussionmentioning

confidence: 84%

Section: Rehabilitation Programmementioning

confidence: 99%

Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home

Wijkstra¹,

Altena²,

Kraan³

et al. 1994

274

161

“…Further improvements are, therefore, unlikely to be obtained by upgrading the occupational therapy component of the programme. DEKHUIJZEN et al [18] found that the ADL score improved in the training group, and that it correlated to well-being. The present results show that this correlation may be the product of simultaneous covariations with other variables (provided that the YQLQ score reflects general well-being) (table 6).…”

Section: Discussionmentioning

confidence: 99%

“…The present results show that this correlation may be the product of simultaneous covariations with other variables (provided that the YQLQ score reflects general well-being) (table 6). Reduced anxiety and depression and improved psychological wellbeing, as reflected in the improved CRDQ score, might also have contributed to the positive effect of the rehabilitation programme on the ADL score [18,19].…”

Section: Discussionmentioning

confidence: 99%

Out-patient rehabilitation improves activities of daily living, quality of life and exercise tolerance in chronic obstructive pulmonary disease

Bendstrup

Jensen²,

Holm³

et al. 1997

161

O Ou ut t--p pa at ti ie en nt t r re eh ha ab bi il li it ta at ti io on n i im mp pr ro ov ve es s a ac ct ti iv vi it ti ie es s o of f d da ai il ly y l li iv vi in ng g, , q qu ua al li it ty y o of f l li if fe e a an nd d e ex xe er rc ci is se e t to ol le er ra an nc ce e i in n c ch hr ro on ni ic c o ob bs st tr ru uc ct ti iv ve e p pu ul lm mo on na ar ry y d di is se ea as se e In this randomized and controlled trial, the main outcome measures were Activiies of Daily Living (ADL) score, York Quality of Life Questionnaire (YQLQ) score, Chronic Respiratory Disease Questionnaire (CRDQ) score, 6 min walking distance (6MWD), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). The rehabilitation programme included physical training, occupational therapy, education, and smoking cessation therapy, and lasted for 12 weeks. The patients were evaluated at entry, halfway through, and at the end of the programme. Follow-up was at 24 weeks.Forty seven patients were recruited, and 16 in each group completed the trial. There were significant differences in the improvements in ADL and CRDQ between the control and the treatment groups at 12 and 24 weeks, and at 24 weeks, respectively. At 6, 12 and 24 weeks, improvements in the 6MWD were 21.6 versus 79.8, 36.1 versus 113.1 and 21.4 versus 96.2 for control and treatment groups, respectively (p<0.004). A correlation matrix showed only ADL and 6MWD to be significantly correlated; the matrix was also used to validate the translated questionnaires. The programme required 124 staff-hours in total.An inexpensive, comprehensive out-patient rehabilitation programme can produce long-term improvement in activities of daily living, quality of life, and exercise tolerance in patients with moderate-to-severe chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2801-2806 Rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) have been shown to have a number of benefits, such as fewer hospital admissions, reduced dyspnoea, improved work tolerance, improved self-esteem, improved sense of well-being, and greater freedom in the activities of daily living. These improvements have largely been achieved with no change in pulmonary function [1][2][3][4][5][6][7][8][9][10][11].Only a few of these studies have included a control group, many were in-patient programmes, and nearly all have focused mainly on a specific aspect of pulmonary rehabilitation: exercise training (respiratory muscle training, upper limb, lower limb, or combination training), education, occupational therapy, or cessation of smoking.The purpose of this study was to set-up and evaluate, using a controlled, randomized design, a comprehensive out-patient programme for patients with COPD, with emphasis upon improvements in activities of daily living, quality of life, and exercise tolerance. The programme was specifically designed to require the modest and economic resources available at most community hospitals. Methods PatientsFrom hospital records of th...

“…Nevertheless, without adherence to an effective exercise maintenance programme, the longevity of any reduction in anxiety demonstrated on completion of a comprehensive pulmonary rehabilitation programme was ,12 months [63,67]. The addition of target-flow inspiratory muscle training to pulmonary rehabilitation did not confer additional benefit [68]. The effects of chronic disease self-management on symptoms of anxiety have not been established [12,22].…”

Section: Pharmacological Therapymentioning

confidence: 99%

Anxiety and depression in end-stage COPD

Hill

Geist²,

Goldstein³

et al. 2008

230

142

Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), estimates of their prevalence vary considerably. This probably reflects the variety of scales and methods used to measure such symptoms. Regardless of whether anxiety and depression are considered separately or as a single construct, their impact on COPD patients is important.A heightened experience of dyspnoea is likely to be a contributing factor to anxiety. Feelings of depression may be precipitated by the loss and grief associated with the disability of COPD. Smoking has been associated with nicotine addiction, and the factors that contribute to smoking may also predispose to anxiety and depressive disorders.Randomised controlled trials indicate that exercise training and carefully selected pharmacological therapy are often effective in ameliorating anxiety and depression. Most medical illnesses are influenced by the psychological responses and coping mechanisms that patients use. However, anxiety and depression are associated with dyspnoea, fatigue and altered sleep, all of which also occur in COPD.An understanding of the psychological history and coping mechanisms of patients and the role of anxiety and depressive reactions to illness may enable clinicians to reduce these symptoms and improve quality of life among patients with chronic obstructive pulmonary disease.KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression C hronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction that is not fully reversible [1]. In addition to the primary pulmonary pathology, the impact of secondary skeletal muscle dysfunction on exercise capacity and survival is well established [2,3]. Psychological impairments, ranging from feelings of depression and anxiety to full diagnostic mental disorders, although prevalent in this population, have received less interest. As COPD is incurable, therapeutic interventions aim to optimise function and slow disease progression [4]. Attention has focused predominantly on the effectiveness of strategies such as smoking cessation [5], longterm oxygen therapy (LTOT) [6,7], influenza vaccines [8], respiratory-specific pharmacological management [9], surgical options [10], conditioning of the peripheral muscles with graduated exercise training [11] and chronic disease selfmanagement strategies [12].Despite the prevalence of depression and anxiety and their impact on the morbidity associated with COPD, these psychological consequences of the disease are rarely addressed, at least in the respiratory medicine community. The purpose of the present review is to raise awareness among pulmonologists, general practitioners and allied health professionals to the secondary psychological impairment associated with COPD. Although anxiety and depression often coexist, they represent separate constructs [13]. Broader reviews of the psychological characteristics of patients with COPD are available [14]. ANXIETY Classification and diagnostic cr...