Chest
Original ResearchPulmonary RehabilitationThe Impact of Anxiety and Depression on Outcomes of Pulmonary Rehabilitation in Patients With COPD
Section snippets
Participants
We studied 238 consecutive patients with COPD who were referred to and completed an established, standardized, 3-week, outpatient PR program at an urban outpatient PR center (Atem-Reha GmbH; Hamburg, Germany) between January 1, 2008, and December 31, 2008. Anamnestic interviews and diagnostic classification were performed by one (out of two) pulmonary physicians according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.1 While participants were seated, spirometry was
Participants
The data of 238 patients were analyzed. In general, the study population was elderly, and 57% were men (Table 1); 63% (n = 151) of the patients lived with a partner, and 37% (n = 87) lived alone. The prevalence of symptoms of anxiety was 41% (n = 98) and of depression, 30% (n = 71).
Effects of PR
Compared with at the start of PR, improvements were observed after PR in 6MWD (P < .001), paralleled by improved dyspnea after the 6MWT (P < .01) (Table 2). Dyspnea at rest remained stable (P > .90), whereas a TDI
Discussion
The present results show that PR was significantly associated with improvements in 6MWD, dyspnea after the 6MWT and during activities, and increased physical and mental QoL, as well as reduced anxiety and depression, which converges with many previous findings.13, 14, 15, 16, 17, 18 Most importantly, we observed that anxiety and depression were related to worse outcomes not only at the start of PR, but also at the end of PR. At both time points, anxiety and depression (after controlling for the
Conclusions
In summary, the present study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during rehabilitation. Therefore, the detection and treatment of anxiety and depression in patients with COPD is of considerable clinical importance.
Acknowledgments
Author contributions: Dr von Leupoldt: contributed to development of the study design, data collection, statistical analyses, and writing of the manuscript.
Dr Taube: contributed to development of the study design, data collection, and writing of the manuscript.
Ms Lehmann: contributed to development of the study design, data collection, and writing of the manuscript.
Dr Fritzsche: contributed to development of the study design, data collection, statistical analyses, and writing of the manuscript.
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Funding/Support: This study was supported by a stipend [Heisenberg-Stipendium, LE 1843/9-1] from the German Research Society (Deutsche Forschungsgemeinschaft) (to A. v. L.).
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