Disease-specific fears impact outcomes of pulmonary rehabilitation in patients with COPD
23 February 2017 (online)
Recent studies demonstrated that anxiety is highly prevalent in patients with COPD and has negative effects on their pulmonary rehabilitation (PR) outcomes. More recently, the relevance of disease-specific fears in COPD has been suggested. However, disease-specific fear is a multifaceted concept and little is still known about how its components relate to outcomes of PR. Therefore, the present study tested how different disease-specific fears relate to different outcomes of PR in patients with COPD.
Before and after a 3-week inpatient PR program, patients with COPD underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears were assessed with the COPD-Anxiety-Questionnaire and Fear Avoidance Questionnaire COPD. In addition, health-related quality of life (QoL), general anxiety, depression, activity-related dyspnea, and dyspnea-related disability were assessed using validated questionnaires.
Multiple regression analyses showed that at the start of PR, higher levels of fear of physical activity, fear of dyspnea, fear of disease progression, fear-avoidance behavior, and fear-avoidance beliefs were associated with worse functional exercise capacity, physical QoL, activity-related dyspnea, and dyspnea-related disability, even after controlling for potential confounding effects of age, sex, lung function, smoking status, and general anxiety. Moreover, greater disease-specific fears at the start of PR predicted more unfavorable levels in these outcomes at the end of PR.
The results show that disease-specific fears negatively impact PR outcomes in COPD patients beyond the effects of general anxiety. Different disease-specific fears, therefore, should be diagnosed and treated in order to improve effects of PR in patients with COPD.