The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD

Thomas Reijnders; Michael Schuler; Michael Wittmann; Danijel Jelusic; Thierry Troosters; Wim Janssens; Nikola M Stenzel; Konrad Schultz; Andreas von Leupoldt

doi:10.1016/j.rmed.2018.12.004

The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD

Respir Med. 2019 Jan:146:87-95. doi: 10.1016/j.rmed.2018.12.004. Epub 2018 Dec 13.

Authors

Thomas Reijnders¹, Michael Schuler², Michael Wittmann³, Danijel Jelusic³, Thierry Troosters⁴, Wim Janssens⁵, Nikola M Stenzel⁶, Konrad Schultz³, Andreas von Leupoldt⁷

Affiliations

¹ Health Psychology, University of Leuven, Leuven, Belgium. Electronic address: thomas.reijnders@kuleuven.be.
² Institute for Psychotherapy and Medical Psychology, University of Würzburg, Würzburg, Germany.
³ Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany.
⁴ Cardiovascular and Respiratory Rehabilitation, University of Leuven, Leuven, Belgium.
⁵ Pneumology, University of Leuven, Leuven, Belgium.
⁶ Clinical Psychology and Psychotherapy, Berlin Psychological University, Berlin, Germany.
⁷ Health Psychology, University of Leuven, Leuven, Belgium.

PMID: 30665524
DOI: 10.1016/j.rmed.2018.12.004

Abstract

Anxiety is a highly prevalent psychological comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has detrimental effects on pulmonary rehabilitation (PR) outcomes. It has been suggested that disease-specific fears could play an even more important role in COPD patients' disease progression. However, little is known about how different disease-specific fears impact COPD. This study examined how different disease-specific fears relate to different PR outcome measures in COPD patients and how these relationships evolve over the course of PR. Before and after a 3-week inpatient PR program, COPD patients (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears (fear of physical activity, fear of dyspnea, fear of disease progression, fear of social exclusion) were assessed with the COPD-Anxiety-Questionnaire-Revised. Health-related quality of life (HQoL), COPD health status, dyspnea in daily life, depression, and anxiety were measured using validated questionnaires. Multiple regression showed that greater disease-specific fears at the start of PR were associated with worse functional exercise capacity, HQoL, health status, and depression at the start and end of PR (controlling for age, sex, lung function, smoking status, and general anxiety). Patients who showed a stronger decrease in disease-specific fears improved more in PR outcome measures over the course of PR. Furthermore, different disease-specific fears were related to different PR outcome measures. The results show that disease-specific fears are associated with treatment outcome measures, both cross-sectionally and prospectively. Therefore, disease-specific fears should be addressed in COPD patients as they might play a significant role in disease progression.

Keywords: Anxiety; COPD; Disease-specific fears; Functional capacity; Pulmonary rehabilitation; Quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anxiety / epidemiology*
Anxiety / psychology
Cross-Sectional Studies
Disease Progression
Dyspnea / epidemiology*
Dyspnea / psychology
Fear / psychology*
Female
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive / psychology
Pulmonary Disease, Chronic Obstructive / rehabilitation*
Quality of Life
Treatment Outcome

Associated data

DRKS/DRKS00004609