Psychosocial Factors Affect Pulmonary Rehabilitation Adherence in COPD Patients

Chronic obstructive pulmonary disease (COPD) patients often face psychological and neuropsychological problems that affect pulmonary rehabilitation outcomes. The prevalence of certain factors, including depressive symptoms, anxiety, mild cognitive impairment (MCI), and self-reported adherence, can assist in predicting patient adherence to prescribed physical exercise and diet.

According to a study published in the International Journal of Chronic Obstructive Pulmonary Disease, pulmonary rehabilitation can decrease symptoms and disability while increasing physical and social activity participation to improve the overall health-related quality of life (HRQoL) in COPD patients. The study’s eligible participants were admitted to an inpatient comprehensive rehabilitation program, where each patient was involved in an individual assessment.

The study’s psychological and neuropsychological assessment included the Hospital Anxiety and Depression Scale; the 30-point Geriatric Depression Scale; the Beck Depression Inventory; the Morisky, Green, and Levine Adherence Scale; the Adherence Schedule in Chronic Obstructive Lung Disease (ASiCOLD) — Revised; the MMSE21; and the Montreal Cognitive Assessment.

Of the 84 patients included in the study, 46.7% of patients had mild-severe depression and 40.5% suffered from anxiety. Depression was determined to be related to autonomous long-term oxygen therapy modifications, disease perception, family support, and MCI.

In addition, 80.3% were considered to have good pharmacological adherence; however, 24.1% had trouble following the prescribed diet and exercise (51.8%). This resulted from other factors in the study, since higher body mass index and depression with low anxiety can be used to predict less adherence to the prescribed exercise.

The researchers were able to draw clinical implications from their data. They recommended more personalized rehabilitative care due to the large presence of MCI, as well as cognitive behavioral therapy to prevent psychological difficulties from interfering with adherence.

“Finally, a self-report tool enabling heath workers to assess both pharmacological and nonpharmacological adherence, such as ASiCOLD, may allow them to focus on these aspects with indisputable advantages for a patient-centered and personalized pulmonary rehabilitative intervention for COPD patients,” the researchers wrote.

The study suggests further studies to be performed due to the limited sample size and to investigate other specific clinical characteristics of the population.