Guell R, Resqueti V, Sangenis M, Morante F, Manorell B, Casan P, Guyatt, GH
Chest. 2006;129:899Y904.
Study Objective:
To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe chronic obstructive pulmonary disease (COPD).
Design:
A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis.
Setting:
A tertiary-care respiratory service.
Patients:
Forty patients (mean age, 65.8 years [SD]) with severe chronic flow limitation (forced expiratory volume in 1 second, 35.13%) without respiratory failure (PaO2, 72.9 mm Hg; PaCO2, 42.5 mm Hg) were randomized either to a control group or to a PR group.
Interventions:
Sixteen weeks of PR that included breathing, retraining, and exercise. Measurements: At baseline and 16 weeks, we evaluated psychosocial morbidity using 2 questionnaires (the Millon Behavior Health Inventory and the Revised Symptom Checklist and measured 6-minute walk distance, and HRQL using the Chronic Respiratory Questionnaire.
Results:
We found differences in favor of the PR group in the following Millon Behavior Health Inventory domains: introversive, forceful, and sensitive personality styles (all P < .05) and chronic tension (P < .01). Results of the depression, hostility, global severity, positive symptom distress index (all P < .01), somatization, anxiety, psychoticism, and positive symptom (all P < 0.05) domains of the Revised Symptom Checklist favored the PR group. We also found statistically and clinically significant differences between groups in 6-minute walk distance (85 m; P < .01) and in 2 domains of the Chronic Respiratory Questionnaire: dyspnea (1.0; P < .01) and mastery (0.6; P < .05). The other 2 domains of Chronic Respiratory Questionnaire showed strong trends in favor of PR group: 0.7 for both fatigue and emotional function (minimal important difference, .5).
Conclusions:
Pulmonary rehabilitation may decrease psychosocial morbidity in COPD patients even when no specific psychological intervention is performed. Findings from this study also confirm the positive impact of PR on functional exercise capacity and HRQL.
Commentary:
Pulmonary rehabilitation has been demonstrated convincingly to improve exercise tolerance, dyspnea, and HRQL for patients with COPD. Psychosocial disturbances including anxiety, depression, social isolation, and chronic stress are very common among patients with COPD, yet a relative paucity of studies investigating outcomes of PR with regard to psychosocial well-being exists. Most studies that have addressed this issue have focused on the impact of PR on anxiety and depression.
In this study, the investigators have performed a prospective, randomized, controlled trial of outpatient PR to assess the impact of PR on psychosocial outcomes among 40 patients with severe COPD, using 2 questionnaires not traditionally used as outcomes measures in PR: The Millon Behavior Health Inventory and the Revised Symptom Checklist. Patients with significant psychiatric disturbances were excluded from the study. The Millon Behavior Health Inventory measures personality styles, attitudes and coping ability with chronic disease (Millon et al, 1994), and the Revised Symptom Checklist measures somatization symptoms, obsessive-compulsive behavior, interpersonal sensitivity, anxiety, depression, hostility, psychoticism, and paranoid ideation (Gonzalez de Rivera et al, 1989). In addition to improvements in 6-minute walk distance, dyspnea, and HRQL (based on the Chronic Respiratory Disease Questionnaire), patients who underwent the PR program had significant gains in psychosocial well-being as assessed by the above-noted questionnaires as compared with control subjects. This study highlights the importance of PR in improving both physical and psychological well-being. It also demonstrates that it may be useful for PR programs to consider broadening the scope of outcomes measures used routinely to include tools specifically designed to measure the indices of psychosocial well-being, to more broadly assess the impact of PR programs worldwide on psychosocial function.
CR