The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD
The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD
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DOI：
10.1016/j.jamda.2016.11.016
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发表时间：
2017-05-01
影响因子：
7.6
通讯作者：
Janssen, Daisy J. A.
中科院分区：
文献类型：
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作者：
Cleutjens, Fiona A. H. M.;Spruit, Martijn A.;Janssen, Daisy J. A.
目的：比较慢性阻塞性肺疾病（COPD）伴和不伴认知功能障碍患者的肺康复（PR）退出率和结局的变化。设计：横断面观察性研究。设置：COPD患者从荷兰的PR中心招募。参与者：研究人群包括157例临床稳定的COPD患者，他们被转诊并完成PR。测量：在PR开始前进行全面的神经心理学检查。功能性运动能力[ 6分钟步行试验（6 MWT）]、疾病特异性健康状态[COPD评估试验（CAT）和St乔治呼吸量表-COPD特异性（SGRQ-C）]、心理健康[医院焦虑和抑郁量表（HADS）]、COPD相关知识、使用独立样本t检验或Mann-Whitney U检验比较有和无认知障碍患者的信息需求[肺部信息需求问卷（LINQ）]。157例COPD患者[平均年龄62.9（9.4）岁时，用力呼气容积在第一秒占54.6%（22.9%）预测值]，24例（15.3%）未完成PR。与无认知障碍的患者相比，有认知障碍的患者的脱落率更高（23.3%和10.3%，P = .03）。PR后PR结局的平均变化在有和没有认知障碍的完成者之间没有差异。6 MWT，CAT，SGRQ-C，HADS和LINQ评分有临床相关改善的患者比例与无认知功能障碍的患者相当。结论：PR是一种有效的治疗COPD和认知功能障碍患者。然而，认知障碍患者没有完成PR计划的风险增加。(C)2016年AMDA -急性后和长期护理医学协会。
Objectives: To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment.Design: A cross-sectional observational study.Setting: Patients with COPD were recruited from a PR centre in the Netherlands.Participants: The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR.Measurements: A comprehensive neuropsychological examination before start of PR was administered. Changes from baseline to PR completion in functional exercise capacity [ 6-minute walk test (6MWT)], disease-specific health status [COPD Assessment Test (CAT) and St George's Respiratory Questionnaire-COPD specific (SGRQ-C)], psychological well-being [Hospital Anxiety and Depression Scale (HADS)], COPD-related knowledge, and their need for information [Lung Information Needs Questionnaire (LINQ)] were compared between patients with and without cognitive impairment using independent samples t tests or Mann-Whitney U tests.Results: Out of 157 patients with COPD [mean age 62.9 (9.4) years, forced expiratory volume in the first second 54.6% (22.9%) predicted], 24 patients (15.3%) did not complete PR. The dropout rate was worse in patients with cognitive impairment compared to those without cognitive impairment (23.3% and 10.3%, P = .03). Mean changes in PR outcomes after PR did not differ between completers with and without cognitive impairment. The proportion of patients with a clinically relevant improvement in 6MWT, CAT, SGRQ-C, HADS, and LINQ scores was comparable for patients with and without cognitive impairment.Conclusion: PR is an effective treatment for patients with COPD and cognitive impairment. Yet patients with cognitive impairment are at increased risk for not completing the PR program. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.