Pulmonary Rehabilitation Research Paper

Pulmonary Rehabilitation has Positive Effects on Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease
Amy Butler

Boise State University

Abstract

Symptoms of anxiety and depression are prevalent in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and are known to worsen patient-centered outcomes and quality of life. Evidence supports the use of pulmonary rehabilitation to effectively manage psychological morbidities in COPD. This review examines whether pulmonary rehabilitation has a positive effect on depression and anxiety in COPD patients.
In recent findings, evidence has shown that pulmonary rehabilitation, which includes exercise training, disease education, and psychosocial
Numerous studies have been conducted on the benefits of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease; however, only a few address its significance in reducing the level of anxiety and depression in those patients. Paz-Dı´az et al. (2006) states that chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease that is frequently associated with anxiety and depression. According to Coventry and Hind (2007), in the management of COPD, pulmonary rehabilitation is widely regarded as the cornerstone of treatment for all patients. In Harrison et al. (2012) longer hospital-based or community-based outpatient rehabilitation programs and shorter, more intensive inpatient rehabilitation programs have both proven to be useful and effective in enhancing physical capacity and health-related quality of life (HRQL) and reducing psychological distress in COPD patients. Along with education, rehabilitation can relieve fears and anxiety associated with chronic lung disease, thereby ensuring long-term dedication to exercising. This paper uses the previous cited articles as well as others to establish the direct positive effect that pulmonary rehabilitation has on anxiety and depression in COPD
The difference in the treatment effect was statistically significant and favored comprehensive rehabilitation over standard care (three studies, n=269; SMD=−0.33, 95% CI: −0.57 to −0.09, P=.008). Comprehensive rehabilitation was still superior to standard care when only the two high quality studies were pooled (SMD=−0.26, 95% CI: −0.51 to −0.01, P=.04). Also in Paz-Dı´az et al. (2006), depression severity as assessed by the Beck Inventory test decreased significantly in the rehabilitation group (14 8 to 6 2, P 0.01), but it did not change in the control group. Similarly, the anxiety trait improved in the group who completed rehabilitation, but it failed to reach statistical significance (35 26 to 19 8, P 0.06). There were no changes in the control group. According to Bratas, Espnes, Rannestad, and Walstad (2010), the anxiety score did not change significantly after rehabilitation (–0.1, p ¼ 545), though there was a significant reduction of the depression score (–0.8, p¼ 002). In Harrison et al. (2012), a patient population 518 patients (57.5% male) with a mean (SD) age of 69.2 years (±8.8 years) were categorized into the 3 predefined HADS sub-groups ('none', 'probable' and 'presence'). The prevalence for symptoms of anxiety was 48.5%, 24.3% and 27.2% and for symptoms of depression was 60.9%, 21.7% and 17.4% respectively. There were