Comprehensive Pulmonary Rehabilitation Results in Clinically Meaningful Improvements in Anxiety and Depression in Patients With Chronic Obstructive Pulmonary Disease
Comprehensive Pulmonary Rehabilitation Results in Clinically Meaningful Improvements in Anxiety and Depression in Patients With Chronic Obstructive Pulmonary Disease
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DOI：
10.1097/hcr.0b013e31828254d4
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发表时间：
2013-03-01
影响因子：
3.8
通讯作者：
ZuWallack, Richard L.
中科院分区：
文献类型：
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作者：
Bhandari, Neha Jain;Jain, Tarun;ZuWallack, Richard L.
目的：肺康复（PR）可改善慢性阻塞性肺疾病患者的焦虑和抑郁。然而，关于其在这些结果中产生有临床意义的改善的能力，人们知之甚少。方法：我们回顾性分析了参加我们为期8周门诊PR计划的366例患者。采用医院焦虑抑郁量表筛查焦虑和抑郁症状（分别为HADA和HADD）；对于两者，>= 10分被认为是异常，1.5个单位或更大的幅度变化被认为是最小临床重要差异（MCID）的阈值。其他结果包括慢性呼吸疾病问卷和6分钟步行测试。结果：在366例患者中，257例（70%）完成了治疗方案，235例（64%）完成了最终结果评估。在项目开始时，25%的人焦虑得分异常，17%的人抑郁得分异常；在完成结局分析的患者中，这两项分别降至9%和6% （P < 0.0001）。异常的HADA和HADD评分预示着不完成该计划。在完成PR的患者中，所有方面都有显著改善（步行距离增加，生活质量提高，抑郁和焦虑症状减轻）。在整个组中，HADA和HADD分别超过了41%和46%的MCID。在完成结果分析的基线焦虑评分异常的患者（n = 44）中，91%超过了MCID，而在入组时抑郁评分异常的患者（n = 30）中，93%超过了MCID。结论：肺部康复可使焦虑和抑郁发生实质性且具有临床意义的改变。
PURPOSE: Pulmonary rehabilitation (PR) improves anxiety and depression in patients with chronic obstructive pulmonary disease. However, little is known regarding its ability to produce clinically meaningful improvements in these outcomes.METHODS: We retrospectively analyzed 366 patients who participated in our 8-week outpatient PR program. The Hospital Anxiety and Depression Scale was used to screen for anxiety and depression symptoms (HADA and HADD, respectively); for both, a score of >= 10 was considered abnormal, and a change of 1.5 units or greater in magnitude was considered the threshold for a minimal clinically important difference (MCID). Other outcomes included the Chronic Respiratory Disease Questionnaire and the 6-Minute Walk Test.RESULTS: Of the 366 patients, 257 (70%) completed the program and 235 (64%) completed final outcome evaluation. At program entry, 25% had abnormal anxiety scores and 17% had abnormal depression scores; these dropped to 9% and 6%, respectively, in those patients completing outcome analyses (P < .0001). Abnormal HADA and HADD scores predicted noncompletion of the program. Among patients who completed PR, there were significant improvements on all dimensions (increased walk distance, increased quality of life, and reduced symptoms of depression and anxiety). Of the total group, the MCID was exceeded in 41% and 46% for HADA and HADD, respectively. Of those with abnormal anxiety scores at baseline who completed outcome analysis (n = 44), 91% surpassed the MCID, while of those with abnormal depression scores at entry (n = 30), 93% surpassed the MCID.CONCLUSIONS: Pulmonary rehabilitation results in substantial and clinically meaningful changes in both anxiety and depression.