Anxiety and depression following pulmonary rehabilitation

Effects of virtual reality-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A meta-analysis

BACKGROUND

Virtual reality (VR)-based pulmonary rehabilitation has been used in the management of chronic obstructive pulmonary disease (COPD). The efficacy of VR-based pulmonary rehabilitation for improving lung function in patients with COPD is controversial. Therefore, the aim of this meta-analysis was to evaluate the efficacy of VR combined with pulmonary rehabilitation for lung function in patients with COPD.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in the Cochrane Library, EMBASE, Web of Science, PubMed, and China National Knowledge Infrastructure databases from inception to February 1, 2023. All included studies were randomized controlled trials that assessed VR combined with pulmonary rehabilitation for COPD patients. The effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (CI). The Cochrane Collaboration tool was used to assess the risk of bias. Publication bias was assessed by Egger test.

RESULTS

A total of 11 studies met the inclusion criteria and were included in this study. The combined effect size showed that VR combined with pulmonary rehabilitation was more effective than pulmonary rehabilitation alone at improving forced expiratory volume in 1 second% (SMD: 0.51; 95% CI 0.19,0.82; P = .002), forced expiratory volume in 1 second/forced vital capacity (SMD: 0.71; 95% CI 0.49,0.93; P < .001), dyspnea (SMD: -0.44; 95% CI -0.66, -0.22; P < .001), and 6-minute walking test (SMD: 059; 95% CI 0.39, 0.79; P < .001). In addition, the VR combined with pulmonary rehabilitation improved depression (SMD: -0.34; 95% CI -0.05, -0.03; P = .033) and anxiety mood (SMD: -0.57; 95% CI -1.11, -0.04; P = .036) compared with the pulmonary rehabilitation group.

CONCLUSION

This meta-analysis indicated that VR regimens could be used to enhance the therapeutic effect of pulmonary rehabilitation in patients with COPD. However, as a rapidly evolving field, more well-designed randomized controlled trials are needed to determine the impact of VR-based pulmonary rehabilitation on COPD patients.

Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review

BACKGROUND

The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures.

OBJECTIVES

This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD).

METHODS

The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel.

RESULTS

We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge.

CONCLUSIONS

This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders.

PROSPERO ID

CRD42017079935.

Does pulmonary rehabilitation alleviate depression in older patients with chronic obstructive pulmonary disease

Objectives:

To identify if pulmonary rehabilitation can achieve a clinically significant alleviation in the level of depression among chronic obstructive pulmonary disease (COPD) patients older than 70 years.

Methods:

We conducted a retrospective secondary analysis of the patients’ electronic records from a major pulmonary rehabilitation center in Cleveland, OH, United States between 2010 and 2014. Profiles of 105 participants who had completed more than 6 pulmonary rehabilitation sessions and were older than 70 years at the time of enrollment in the program were included. The Beck Depression Inventory scores at the baseline and the end of the pulmonary rehabilitation sessions were compared.

Results:

There was a statistically and clinically significant reduction in mean scores of depression from the baseline to the end of pulmonary rehabilitation: mean± SD: 104±5.6; p=0.00. The mean±SD depression score at the end was 9±4.3 compared with the baseline 17±7.8. Seventy-seven (73%) participants showed clinically significant improvement in depression; however, 20 participants (27%) had no clinically significant improvement, and 8 (8%) had worse depression at the end of pulmonary rehabilitation. Participants with higher depression scores at the baseline were 1.3 times more likely to achieve clinically significant alleviation in depression at the end of rehabilitation (odds ratio = 1.3, p=0.00).

Conclusion:

Pulmonary rehabilitation induced clinically significant alleviation in depression among participants with COPD aged over 70 years.

Strategies to improve anxiety and depression in patients with COPD: a mental health perspective

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities.

Maintaining Gains Following Pulmonary Rehabilitation

PURPOSE

Pulmonary rehabilitation (PR) is an accepted intervention for individuals with chronic obstructive pulmonary disease. Despite initial improvements following PR, many patients eventually return to baseline function or decline even further. The aim of this study is to look at long-term (>1 year) outcomes following PR.

METHODS

This was a prospective cohort study of patients who had completed PR. Participants were invited for an assessment consisting of participant interviews and clinical assessments using standardised instruments.

RESULTS

129 patients between 2003 and 2012 completed rehabilitation and were eligible. 88 patients were included in the analysis. The mean time of the long-term assessment was 22 months following PR. The mean age was 71 years. Mean FEV1 was 46%. There was a statistically significant (p < 0.001) increase in the incremental shuttle walk test distance of 29.0 m following PR but this gain was lost at the long-term reassessment. Chronic Respiratory Questionnaire (CRQ) scores showed a statistically significant (p < 0.001) increase in all four domains but only the domains of dyspnoea and fatigue remained statistically significant (p < 0.001, p < 0.01, respectively) at the long-term reassessment. Hospital Anxiety and Depression Scale scores reduced following rehabilitation but only the anxiety component was statistically significant (p < 0.01). These improvements persisted at the long-term reassessment but were not statically significant.

CONCLUSIONS

This study confirms that many of the functional gains achieved in PR are lost in the longer term. Regular surveillance or monitoring of these patients post-PR is important to identify those requiring further intervention.

The relationships of self-efficacy, physical activity, and paid work to health-related quality of life among patients with chronic obstructive pulmonary disease (COPD)

Purpose

Although chronic obstructive pulmonary disease (COPD) primarily affects the lungs, it is regarded as a systemic disorder associated with comorbidity and physical deterioration, which often results in reduced levels of health-related quality of life (HRQoL). Self-efficacy is an important concept in self-management, which is vital for improving HRQoL in patients with COPD. The purpose of this study was to examine how general self-efficacy, leisure time physical activity, and sociodemographic variables such as employment status are related to the physical and mental health components of HRQoL in patients with COPD.

Patients and methods

In this cross-sectional study, 97 COPD patients (54.6% male, mean age 64.6 years, standard deviation [SD] 9.5) beginning a pulmonary rehabilitation program completed three self-report questionnaires: the short form (SF)-12v2 Health Survey as a measure of HRQoL; the General Self-Efficacy Scale; and a standardized instrument measuring regular leisure time physical activity.

Results

The physical health component median score was 31.3 (interquartile range [IQR] 16.3) and the mental health component median score was 45.9 (IQR 21.5). Two sets of linear regression analyses were performed, one predicting physical health and the other predicting mental health. The first analysis showed that better physical health was directly related to being in paid work (P-value <0.001), but was not significantly related to age, sex, marital status, education, work status, physical activity, or self-efficacy. In the second analysis, better mental health was directly related to living with a partner, being physically active, and having higher self-efficacy (P-value <0.001).

Conclusion

The findings suggest that general self-efficacy has differential relationships to the two dimensions of HRQoL. Our results indicate that general self-efficacy, physical activity, and paid work might be important factors for improving HRQoL of persons with COPD, and should be taken into consideration in pulmonary rehabilitation.