Have we underestimated the efficacy of pulmonary rehabilitation in improving mood?

• Published in: Respiratory medicine 2012-06, Vol.106 (6), p.838-844
• Main Authors: Harrison, S.L, Greening, N.J, Williams, J.E.A, Morgan, M.D.L, Steiner, M.C, Singh, S.J
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Anxiety; Anxiety - etiology; Anxiety - rehabilitation; Biological and medical sciences; Body mass index; Chronic obstructive pulmonary disease, asthma; Comparative Effectiveness Research; COPD; Depression; Depression - etiology; Depression - rehabilitation; Exercise Test - methods; Exercise Therapy - methods; Female; Hospital anxiety and depression scale; Hospitals; Humans; Lung diseases; Male; Medical research; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Mortality; Patient Dropouts - psychology; Patient education; Pneumology; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Pulmonary/Respiratory; Qualitative research; Questionnaires; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Treatment Outcome; Walking
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2011.12.003

Summary Background Patients with COPD have a high prevalence of anxiety and depression. The efficacy of pulmonary rehabilitation (PR) in treating more severe anxiety and depression is unknown. The study aimed to explore the effectiveness of PR in reducing symptoms of anxiety and depression across a spectrum of severities. Methods The study used principles of comparative effectiveness research. Data was analysed from 518 patients with COPD [57.5% male, mean (SD) age 69.2 years (±8.8 years)]. Patients were categorised into 3 groups based on their hospital anxiety and depression scale (HADS) scores pre PR (‘none’ 0–7, ‘probable’ 8–10 and ‘presence’ 11–21). A responder was defined as achieving a change of ≥48m on the incremental shuttle walk test (ISWT). Patients were categorised as ‘completers’ if they attended their discharge assessment for PR. Results Anxiety and depression did not reduce following PR in patients with no symptoms ( p  > 0.05). Patients with a ‘probable’ or ‘presence’ of symptoms had significant reductions (both p   0.05). Conclusion PR is effective in reducing symptoms of anxiety and depression. Previous studies may have underestimated the effectiveness of the PR programme in improving mood.