Original article
Psychosocial Conditions Do Not Affect Short-Term Outcome of Multidisciplinary Rehabilitation in Chronic Obstructive Pulmonary Disease

https://doi.org/10.1016/j.apmr.2005.03.030Get rights and content

Abstract

Trappenburg JC, Troosters T, Spruit MA, Vandebrouck N, Decramer M, Gosselink R. Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease.

Objectives

To characterize patients referred for pulmonary rehabilitation on a large number of psychologic and sociodemographic variables and to determine the contribution of these variables on the response to rehabilitation.

Design

Cross-sectional, explorative.

Setting

University hospital and outpatient clinic.

Participants

Eighty-one consecutive patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 40%±16% of predicted) were included in outpatient pulmonary rehabilitation.

Intervention

Multidisciplinary rehabilitation program.

Main Outcome Measures

Pulmonary function, exercise capacity (Wmax, 6-minute walk test [6MWT]), Chronic Respiratory Disease Questionnaire (CRDQ), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) were assessed before and after 3 months rehabilitation. In addition, psychosocial adjustment, social support, marital status, mode of transportation, education, employment, and smoking status were assessed at the start of the rehabilitation.

Results

Rehabilitation improved exercise performance (Wmax, 6±12W; P<.01; 6MWT, 41±72m; P<.001), quality of life (CRDQ score, 12±13 points; P<.001), functional status (PFSDQ-M activity score, −8±11 points; PFSDQ-M dyspnea score, −6±12 points; PFSDQ-M fatigue score, −4±8 points; all P<.01), HADS anxiety score (−2±3 points, P<.01), and HADS depression score (−3±3 points, P<.001). In single regression analysis, only baseline depression was weakly negatively correlated with the change in maximal workload. No other relations of initial psychologic or sociodemographic variables with outcome were observed.

Conclusions

The effects of rehabilitation are not affected by baseline psychosocial factors. Patients with less favorable psychologic or sociodemographic conditions can also benefit from pulmonary rehabilitation. The multidisciplinary approach of the rehabilitation program might have contributed to this improvement.

Section snippets

Subjects and Design

We investigated 81 consecutive patients with COPD visiting the outpatient clinic for enrollment in a pulmonary rehabilitation program, prospectively. Patients who met the following 4 criteria were eligible for inclusion: (1) forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) below 70%; (2) clinical condition stable at inclusion with no recent exacerbation; (3) symptoms of dyspnea and reduced exercise capacity present despite optimal medical care; and (4) willing to

Results

Eighty-one patients entered the outpatient rehabilitation program, while 65 patients completed the 12-week program. Baseline physiologic characteristics of the rehabilitation group are shown in table 1. On the average, patients fell in stage II through IV of the Global Initiative for Chronic Obstructive Lung Disease scale and had impaired maximal and functional exercise capacity. Psychologic and sociodemographic parameters are summarized in table 2. HRQOL was markedly impaired, as can be

Discussion

The patients studied in the present trial had considerable impairment of physical and functional performance, psychologic problems (40%), average level of social support, and severe psychosocial adjustment problems (60%). The present study demonstrates that outcome of rehabilitation was independent of baseline psychologic and sociodemographic characteristics. Patients with depression and anxiety also responded to rehabilitation. Level of social support, marital status, family composition, level

Conclusions

Irrespective of their psychologic and sociodemographic conditions prior to rehabilitation, patients with COPD can benefit from pulmonary rehabilitation. Symptoms of anxiety or depression, psychosocial adjustment problems or lack of social support per se are not exclusion criteria for a multidisciplinary pulmonary rehabilitation. The specific role of the disciplines in a multidisciplinary approach in controlling potential disturbing concomitants has to be established in future research.

Acknowledgments

We thank the members of the respiratory rehabilitation team: Anne Cattaert, Linda Stans, Iris Coosemans, Veronica Barbier, Paul Baten, Dirk Delva, Geert Celis, and Peter Bogaerts for their assistance in this study.

References (33)

  • C.F. Emery et al.

    Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease

    Health Psychol

    (1998)
  • R. ZuWallack

    Selection criteria and outcome assessment in pulmonary rehabilitation

    Monaldi Arch Chest Dis

    (1998)
  • T. Troosters et al.

    Exercise training in COPDhow to distinguish responders from nonresponders

    J Cardiopulm Rehabil

    (2001)
  • D.J. Sinclair et al.

    Controlled trial of supervised exercise training in chronic bronchitis

    BMJ

    (1980)
  • F. Maltais et al.

    Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1997)
  • S. Foster et al.

    Pulmonary rehabilitation in COPD patients with elevated Pco2

    Am Rev Respir Dis

    (1988)

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    Supported by FWO-Vlaanderen (grant nos. 7.0007.00, G.0237.01) and Katholieke Universiteit (grant no. PDM 04/230).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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    Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.