Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study

Factors Influencing Compliance with Pulmonary Rehabilitation in Patients with Stable COPD: a Cross Sectional Study

Background

Pulmonary rehabilitation (PR) is recognized as a cost-effective non-pharmacological treatment modality to promote quality of life and delay disease progression in patients with chronic obstructive pulmonary disease (COPD). Although PR has been shown to be effective, it is underutilized in clinical practice. This study aimed to investigate the factors associated with affecting compliance with PR in stable COPD patients.

Methods

This study is a cross-sectional survey. Patients with stable COPD were included using convenience sampling method. Data were collected using questionnaires including the demographic questionnaire, PR Compliance Questionnaire, mMRC dyspnea Scale, Family Support Scale, and Chronic Disease Self-Efficacy Scale (SES6G). Univariate analysis and multiple linear regression analysis were used to analyze the data.

Results

The 100 patients with stable COPD were moderately compliant with PR (3.51 ± 0.65), with the highest compliance with medication (4.10 ± 0.86) and the lowest with exercise (3.03 ± 1.16). Univariate analysis showed statistically significant influences on PR compliance were gender (P = 0.029), educational level (P = 0.021), exercise habits (P < 0.01), willingness to PR (P < 0.01), difficulty of PR (P = 0.030), mMRC (P = 0.002), and SES6G (P = 0.002). The following equation represents the multiple linear regression model: PR compliance = 0.235 × exercise habits + 0.609 × willingness to PR + 0.325 × difficulty of PR (P < 0.0001), adjusted R2 = 0.330, F=7.974, and Durbin-Watson ratio = 2.049. Patients' good exercise habits in regular life, stronger willingness to PR, and easier PR programs may contribute to improved PR compliance.

Conclusion

This study suggested that stable COPD patients were not sufficiently compliant with PR and revealed related important factors affecting the compliance. Exercise habits, willingness to PR, and PR difficulty were found to be significant influencing factors. The results of this study can provide evidence for developing a more appropriate PR program and promoting PR compliance in the future.

Fatigue Related COPD From Patient's Perspectives

OBJECTIVES

Fatigue is a common symptom in patients with the chronic obstructive pulmonary disease (COPD). The aim of this study was to assess patient-reported fatigue in the COPD and to investigate their attempts to cope with it.

METHODS

This cross-sectional study was conducted with 62 patients diagnosed with the COPD. Individual Introduction Form, Fatigue Intervention Form and Visual Analog Scale were used to collect research data. The data were presented in the form of numbers, percentages, means and standard deviations, while Chi-Square, Fisher Freeman Halton and Pearson Correlation analysis were applied in statistical analysis.

RESULTS

Patients have moderate fatigue, with a score of 6.91 ± 2.81 out of 10 and they experience fatigue for 4.95 ± 2.19 days in a week. Patients reported that the most common causes of fatigue were stress, illness and advanced age. They also mentioned feeling unhappy and angry due to fatigue, adopted a sedentary lifestyle, and being unable to do housework. The most common attempts made by patients to cope with fatigue are sleeping, taking a warm shower and using medication, while less frequently used methods include watching movies, praying, getting a massage and listening to music.

CONCLUSION

Patients diagnosed with the COPD frequently experience moderate fatigue, which can have harmful effects on their daily lives. In response, patients often implement strategies to conserve energy, with the aim of managing the fatigue symptoms. Nurses should routinely assess the fatigue status of the COPD patients and counsel them on coping with fatigue.

Self-management behavior and its influencing factors among adults with chronic obstructive pulmonary disease in Colombo, Sri Lanka: A cross-sectional study

Background

Self-management behaviors are essential to take care of chronic obstructive pulmonary disease (COPD). However, data on COPD self-management practices in Sri Lankan adults is limited. Therefore, identifying the level of COPD self-management and examining its influencing factors are essential for healthcare providers to manage COPD effectively.

Objectives

This research aimed to describe the level of self-management behaviors and determine whether dyspnea, perceived stress, COPD knowledge, and social support can predict self-management in adults with COPD in Colombo, Sri Lanka.

Methods

A predictive correlational study was conducted, and 108 adults with mild to moderate COPD were recruited from the central chest clinic in Colombo, Sri Lanka, from March to April 2024 using a simple random sampling technique. A self-administered questionnaire was used to gather data included demographic characteristics. The other instruments used were the COPD Self-Management Scale, the Perceived Stress Scale, the COPD Knowledge Questionnaire, and the Perceived Social Support Scale. Descriptive statistics and multiple regression were used for data analysis.

Results

The study showed a moderate self-management level with a mean of 3.04 ± 0.35. All variables could explain 41.7% of the variance in self-management among adults with mild to moderate COPD and COPD self-management behaviors significantly predicted by dyspnea (β = 0.212, p = 0.006), perceived stress (β = -0.195, p = 0.018), COPD knowledge (β = 0.263, p = 0.001), and perceived social support (β = 0.366, p <0.001).

Conclusion

The study shows evidence that a program to intervene targeting COPD knowledge and perceived social support, in addition to reducing dyspnea and perceived stress, can be beneficial in promoting better self-management behaviors among adults with mild to moderate COPD.

The effect of dignity therapy on anxiety and depression in patients with chronic obstructive pulmonary disease: A randomized clinical trial

BACKGROUND

Anxiety and depression can prolong the treatment process and impose financial burdens on the health system in chronic obstructive pulmonary disease. Dignity therapy is one of the methods of eliminating these symptoms. The present study was conducted to investigate the effect of dignity therapy on the severity of anxiety and depression in patients with chronic obstructive pulmonary disease.

MATERIALS AND METHODS

This clinical trial was conducted on 62 patients with chronic obstructive pulmonary disease, referring to the comprehensive respiratory clinic of Khorshid Hospital (Isfahan, Iran) in 2021. The patients were randomly allocated to intervention and control groups. Each patient of the intervention group underwent dignity therapy for four 45-60-min sessions, whereas no intervention was performed in the control group. Data were collected using demographic information questionnaire and Hospital Anxiety and Depression Scale (HADS), before the intervention and one month after the completion of the intervention in two groups. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA) as well as descriptive (mean, standard deviation, frequency, and percentage) and inferential (Chi-square, independent t-test, and paired t-test) statistics.

RESULTS

The mean score of anxiety of the patients before the intervention was not significantly different between the two groups (P = 0.18); but one month after the intervention, it was significantly lower in the intervention group than in the control group (P = 0.05). Also, the score of depression was not significantly different between the two groups before (P = 0.68) and one month after the intervention (P > 0.05).

CONCLUSION

Dignity therapy could reduce anxiety in patients with chronic obstructive pulmonary disease; thus, it could be used as a nonpharmacological, cost-effective and probably without side effects method.

Path analysis of the effect of positive psychological capital on health-promoting lifestyle in patients with COPD after pulmonary rehabilitation: An observational study

To investigate the effect of positive psychological capital on the health-promoting lifestyle of patients with chronic obstructive pulmonary disease (COPD) and the intermediary effects of life satisfaction and learned helplessness. A total of 482 patients who completed the pulmonary rehabilitation course at the Nantong Sixth People's Hospital of Jiangsu Province were surveyed using a self-designed questionnaire battery, encompassing the positive psychological capital, health-promoting lifestyle, life satisfaction, and learned helplessness scales. A total of 469 of the 482 questionnaires distributed were effectively returned, leading to an effective response rate of 97.3%. The mean scores on the positive psychological capital, life satisfaction, learned helplessness, and health-promoting lifestyle scales were 105.56 ± 10.44, 19.89 ± 6.33, 50.14 ± 5.47, and 104.22 ± 10.44, respectively. The structural equation model demonstrated good fit indexes. The path analysis revealed that positive psychological capital had a direct effect of 0.431 on health-promoting lifestyle, while life satisfaction and learned helplessness had a mediating effect on this relationship (both P < .05). Patients with COPD have low levels of positive psychological capital and health-promoting lifestyle. Thus, addressing psychological problems and providing continuous rehabilitation nursing to strengthen the psychological construct are essential in this patient group. Moreover, the positive psychological capital of patients with COPD can directly predict their health-promoting lifestyle and exert an influence via the chain mediating effect of life satisfaction and learned helplessness. Therefore, clinical medical staff should assess the positive psychological capital of patients with COPD and adjust the daily rehabilitation activities according to the patients' mental state. Furthermore, enhancing the patients' life satisfaction by employing diverse strategies to reduce learned helplessness can notably improve the health-promoting lifestyle of those with COPD.

Analysis of the relationship between perceived stress level and death anxiety in individuals with COPD

OBJECTIVES

The study aimed to investigate the relationship between perceived stress level and death anxiety in individuals with COPD.

METHOD

It was planned with a descriptive and relational screening design. It was carried out with the participation of 132 patients diagnosed with COPD. The study data were collected through Patient Information Form, Perceived Stress Scale, and Death Anxiety Scale. Descriptive statistics and multiple regression analysis were used in data analysis.

RESULTS

The COPD patients' total perceived stress scale and perceived insufficient self-efficacy and perceived stress/distress subscale mean scores were found as 32.75 ± 5.32, 15.81 ± 3.60, and 16.93 ± 2.97, respectively. The patients' Anxiety total scale mean score was determined to be 6.96 ± 3.40. A positive and statistically significant relationship was found between COPD patients' Perceived Stress total scale mean score and their Death Anxiety Scale mean score (F = 4.332, p < 0.05).

CONCLUSION

Perceived stress level of COPD patients was found to be at a high level, while their death anxiety level was determined as moderate. It was also determined that as perceived stress levels of the patients increased, their death anxiety levels also increased.

Proprietary Model of Qualification for In-Hospital Rehabilitation after COVID-19

BACKGROUND

Since the beginning of the SARS-CoV-2 epidemic in Poland, 6,128,006 people have been diagnosed, of which 116,798 died. Patients who recovered from COVID-19 and require rehabilitation due to varied impairments should be provided an opportunity to participate in an individualized, complex rehabilitation program starting from acute care and being continued in the post-acute and long-term rehabilitation phase. It is recommended to offer out-patient and in-hospital rehabilitation procedures depending on the type and persistence of symptoms and dysfunctions. The aim of this paper is to present the qualification process of post-COVID19 patients for an in-hospital complex rehabilitation program developed on the basis of pulmonary physical therapy.

METHODS

The presented qualification program was developed on the basis of clinical experience of over 2000 patients participating in the pilot program of in-hospital rehabilitation launched in September 2020 and based on the Regulation of the Polish Minister of Health of 13 July 2020.

RESULTS

The proposed model of patients' qualification rests on well-known and validated tools for functional assessment: exercise tolerance assessment, dyspnea intensity assessment, functional fitness assessment, assessment of arterial blood saturation, lung ventilation function assessment, assessment of long-lasting COVID-19 symptoms, and patient's basic mental health condition.

CONCLUSIONS

The proposed qualification model for the post-COVID rehabilitation program allows us to introduce adequate qualifications followed by much needed assessment of the health effects.

The Relationship Between Hospitalization Frequency of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Anxiety and Depression

Depression and anxiety are common in patients with COPD (chronic obstructive pulmonary disease), and anxiety and depression can increase the risk of hospitalization and the acute exacerbation of chronic obstructive pulmonary disease. The relationship between the frequency of hospitalization for acute exacerbation of COPD (AECOPD) and the anxiety and depression of patients is not fully understood. This study aims to analyze the relationship between the frequency of hospitalizations and anxiety and depression of patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). A collection of 309 AECOPD patients admitted to the emergency department in our hospital from 2019 to 2020 were divided into anxiety group A and depression group D according to the Hospital Anxiety and Depression Scale (HADS) score and divided into A1 and D1 negative groups (≤7 Score), A2 and D2 suspicious groups (8-10 points), A3 and D3 confirmed groups (≥11 points) for paired analysis of anxiety and depression correlation and difference and comparison of the frequency of hospitalization in each group within 2 years. The results found that anxiety and depression were significantly positively correlated (r = 0.654, p = 0.000). Intra-group comparison shows that the difference between the anxiety-diagnosed and non-diagnosed groups and the depression subgroups are statistically p < 0.05; the comparison between the anxiety subgroup and the depression subgroup showed that there was a statistical difference between the confirmed group and the non-diagnosed group (p < 0.01). In short, AECOPD anxiety is positively correlated with depression, and depression is affected by the frequency of hospitalization earlier and gradually, and anxiety should be prioritized in the acute phase.

Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis

Background

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease which feature is progressive airflow obstruction. Singing is a popular and convenient activity that requires people to manage their lung volumes and airflow actively. Despite the well-known benefits of singing to healthy people, the specific effect still remains unclear.

Objective

To investigate the mental and psychological benefits of singing in patients with stable COPD.

Search Methods

We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) on randomized controlled trials (RCTs) including singing exercise as the main intervention in stable COPD. We searched 8 electronic databases, including Web of Science, PubMed, Embase, Cochrane Library, Clinical Trials.gov, and the Physical Therapy Evidence Database (PEDro), CNKI, and Wanfang Database from inception until May 2022. The searching languages was English or Chinese. Data extraction using standardized templates was performed by two independent reviewers. The quality of the studies was assessed using the PEDro scale. Data synthesis was performed with Revman 5.4. The pooled effect sizes are reported by MD and 95% CI.

Results

Five RCTs involving 333 patients with stable COPD were included in this meta-analysis. Singing was regarded as the main intervention in the experimental group. Meta-analysis revealed that singing improves quality of life on Short Form 36 physical component summary (SF-36 PCS) (MD = 12.63, 95% CI: 5.52 to 19.73, P < 0.01) and respiratory muscle in maximal expiratory pressure (PE_max) (MD = 14.30, 95% CI: 0.87 to 27.73, P = 0.04) in patients with COPD. However, it has limited effects on Short Form 36 mental component summary (SF-36 MCS), lung function, exercise capability, and adverse mental state.

Conclusion

Based on results of the meta-analysis, singing could be used to improve quality of life (SF-36 PCS) and respiratory muscles (PE_max) in patients with COPD.

Resilience and Subjectively Experienced Stress Among Paramedics Prior to and During the COVID-19 Pandemic

INTRODUCTION

Paramedics play a vital role in the healthcare system by providing professional support in situations of direct threat to patient health and life. They experience numerous difficulties during their work, which result in occupational stress. During the COVID-19 pandemic, their work has become even more demanding. The aim of the current study was to examine the role of resilience in the subjective experience of stress among paramedics during the COVID-19 pandemic.

MATERIALS AND METHODS

The study was carried out in two phases, in October-November 2019 (N = 75) and in May-June 2020 (N = 84), using the Sense of Stress Questionnaire (Skala Poczucia Stresu) and the Resilience Scale (Skala Pomiaru Prężności).

RESULTS

Paramedics exhibited higher intrapsychic stress before the COVID-19 pandemic. Tolerance of failure and treating life as a challenge were higher during the pandemic, in contrast to optimism and the ability to mobilize in difficult situations. Paramedics who were in contact with patients with COVID-19 experienced higher stress. Perseverance and determination, openness to new experiences and sense of humor, as well as competences and tolerance of negative emotions were revealed to play a key part in mitigating subjectively experienced stress.

CONCLUSION

Paramedics' subjectively experienced stress was lower during the COVID-19 pandemic. Paramedics who were in direct contact with patients with COVID-19 experienced higher stress. They had sufficient psychological resources, in the form of resilience (perseverance and determination, openness to new experiences, sense of humor, and competences and tolerance of negative emotions), which allowed them to cope with the situation of the COVID-19 pandemic.