Disability in Valued Life Activities in COPD

描述(由申请人提供)：本项目是R01《评估慢性阻塞性肺病的职业负担》的直接结果，也是R01竞争性续签的重新提交。尽管慢性阻塞性肺病很常见，成本也很高，但仅靠患病率统计和经济估计不能反映其对个人的影响。慢性阻塞性肺病导致许多身体和认知方面的限制，并与工作残疾和日常生活能力限制密切相关。慢性阻塞性肺疾病还可能在其他一系列生活活动中造成困难，如与朋友交往、旅行或参与兴趣爱好，尽管这方面的研究较少。除了生存或自给自足所必需的活动之外，个人认为有意义或令人愉快的广泛活动，就是我们所说的“有价值的生活活动”(VLA)。VLA的表现似乎与心理健康和对功能的满意度密切相关。与一般功能下降相比，VLA的残疾被证明是随后发生新的抑郁症状的更强的预测因素。 这项研究将描绘出将呼吸道疾病，特别是慢性阻塞性肺病与身体和认知功能联系起来，进而将功能与残疾联系起来，将残疾与心理困扰联系起来；并在Verbrugge和Jette残疾模型的基础上，确定可能改变这些途径的因素。数据将通过四次年度电话采访和两次家访收集。评估VLA残疾和心理结果的项目，以及关于VLA残疾和心理痛苦的潜在风险和保护因素的问题，将包括在访谈中。肺功能、生物特征和性能数据将在家访中收集。基于研究模型(图1)的分析将集中在三个主要领域：(1)勾勒出COPD患者在4年内导致残疾和痛苦的途径，(2)确定与功能受限后VLA维持相关的因素，以及(3)确定与VLA残疾后维持心理健康相关的因素。将开发统计模型，以便在研究模型的背景下使用横断面分析和纵向分析来描述这些关系。这项研究的结果将提供有助于将VLA残疾和VLA残疾可能导致的心理痛苦降至最低的信息，从而提高COPD患者的生活质量。

DESCRIPTION (provided by applicant): This project is a direct outgrowth of the R01 "Assessing the Occupational Burden of COPD," and is the resubmission of a competitive renewal of that R01. Although COPD is common and costly, prevalence statistics and economic estimates alone cannot capture its impact on individuals. COPD leads to a host of physical and cognitive limitations and is strongly linked to work disability and limitations in activities of daily living. COPD may also cause difficulty in a wide array of other life activities, such as socializing with friends, traveling, or participating in hobbies, although this is less studied. The wide range of activities that individuals find meaningful or pleasurable, above and beyond activities necessary for survival or self-sufficiency, is what we term "valued life activities" (VLAs). Performance of VLAs appears to be strongly linked to psychological well-being and satisfaction with function. Disability in VLAs has been shown to be a stronger predictor of the subsequent onset of new depressive symptoms than decline in general function. This study will delineate the pathways linking airways disease, and COPD specifically, to physical and cognitive functioning, and, in turn, linking functioning to disability, and disability to psychological distress; and identify factors that may modify those pathways, building on the Verbrugge and Jette model of disablement. Data will be collected in four annual telephone interviews and two home visits. Items to assess VLA disability and psychological outcomes, as well as questions about potential risk and protective factors for VLA disability and psychological distress, will be included in the interview. Lung function, biometric, and performance data will be collected in home visits. Analyses based on the study model (Figure 1) will focus on 3 major areas: (1) delineating the pathways leading to disability and distress among individuals with COPD over a 4-year period, (2) identification of factors associated with maintenance of VLAs after development of functional limitations, and (3) identification of factors associated with maintenance of psychological well-being after VLA disability. Statistical models will be developed to describe these relationships in the context of the study model, using both cross-sectional and longitudinal analyses. The findings from this study will provide information that may help minimize VLA disability and the psychological distress that might result from VLA disability, thereby improving quality of life of persons with COPD.