Disability in Valued Life Activities in COPD

描述（由申请人提供）：本项目是R 01“评估COPD的职业负担”的直接产物，是R 01竞争性更新的重新提交。虽然COPD很常见且费用高昂，但仅凭流行率统计和经济估计无法反映其对个人的影响。COPD导致许多身体和认知限制，并与工作残疾和日常生活活动的限制密切相关。COPD还可能导致其他生活活动的困难，例如与朋友社交，旅行或参与爱好，尽管这是研究较少。除了生存或自给自足所必需的活动之外，人们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功能满意度密切相关。与一般功能下降相比，VLA的残疾已被证明是随后新发抑郁症状的更强预测因子。 这项研究将描绘气道疾病，特别是COPD，身体和认知功能的途径，并反过来，连接功能残疾，残疾心理困扰;并确定可能修改这些途径的因素，建立在Verbrugge和Jette残疾模型。数据将通过四次年度电话访问和两次家访收集。评估VLA残疾和心理结局的项目，以及关于VLA残疾和心理困扰的潜在风险和保护因素的问题，将包括在访谈中。将在家庭访视中收集肺功能、生物特征和性能数据。基于研究模型的分析（图1）将集中在3个主要领域：（1）描述4年内COPD患者导致残疾和痛苦的途径，（2）确定功能限制发生后维持VLA的相关因素，（3）确定VLA残疾后维持心理健康的相关因素。将开发统计模型来描述这些关系的研究模型的背景下，使用横截面和纵向分析。本研究的结果将提供有助于最大限度地减少VLA残疾和可能由VLA残疾导致的心理困扰的信息，从而改善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.