Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Influence of Coping Strategies on Short and Long-term Outcomes of Pulmonary Rehabilitation in Patients With Idiopathic Pulmonary Fibrosis (IPF) and Chronic Obstructive Pulmonary Disease (COPD)
The aim of this prospective observational trial is to evaluate the influence of Coping strategies on pulmonary rehabilitation outcomes like 6-minute walk distance and Quality of life.
In the recent pulmonary rehabilitation (PR) statement of the American Thoracic Society/
European Respiratory Society, PR is mentioned to be beneficial by improving exercise
capacity, symptoms and quality of life in patients with other chronic respiratory diseases
than chronic obstructive pulmonary disease (COPD) (1). Although patients with idiopathic
pulmonary fibrosis (IPF) often suffer from psychological distress such as symptoms of anxiety
and depression, only little is known about the impact of these mental co-morbidities on PR
outcomes.
In a former study the investigators demonstrated that patients with IPF benefit well from an
inpatient PR program of only 3 weeks duration by improving exercise capacity (6-Minute walk
distance), health-related quality of life as well as symptoms of anxiety and depression.
During the 3-months follow-up after PR, most of these improvements disappeared so that this
group showed similar values at follow-up compared to baseline. However, in contrast patients
from the control-group with usual care worsened significantly during the 6 months study
period.
Interestingly, a linear regression analysis revealed that IPF patients with lower levels of
anxiety showed the tendency to have the best sustainability in exercise capacity at the 3
months follow-up. Given that maintenance of exercise capacity may be crucial to influence
prognosis and the risk of mortality, reducing symptoms of anxiety might be of special
interest.
The negative influence of anxiety symptoms on exercise capacity is a new finding in IPF
patients but already known in the field of other chronic diseases: in patients with chronic
pain and recently also in patients with COPD, "fear avoidance" behavior is discussed as
having a direct negative influence on daily physical activity levels. COPD patients seem to
develop fear/anxiety of exercise-related dyspnea due to classical and operant conditioning.
This may lead to consecutive avoidance of physical activity and other exercises in daily life
(2).
Anxiety symptoms and psychological distress have been shown to be related to patients
individual illness perceptions and their way of coping with the disease like e.g.
problem-focusing coping, looking for information, depressive coping.
In patients with IPF, the role of coping styles in the context of PR has not been
investigated yet. It is unclear whether anxiety symptoms are influenced by individual
characteristics of IPF patients such as specific coping strategies and illness perceptions
and therefore, whether individual coping strategies might have an influence on the PR
outcome.
This latter might be an underestimated issue influencing the PR effects in patients with
chronic respiratory diseases. Better knowledge in this field is of special clinical
importance in order to ensure short- und long term PR success. Potential differences in
psychological profiles or coping strategies between COPD and IPF patients might result in
disease-specific interventions during and after PR.
Therforme, aim of this study is to evaluate the influence of coping strategies on pulmonary
rehabilitation outcomes.
This study is a prospective observational trial. Asssessments will take place at admission of
the rehabilitation program, at discharge and partially after 3-month.
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