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Effectiveness of a structured physical rehabilitation program for Chinese population with depressive disorders—a randomised controlled trial
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Research Report Platform Presentation Number: RR-PL-1770 Saturday 2 May 2015 11:51 Room 303–304 EFFECTIVENESS OF A STRUCTURED PHYSICAL REHABILITATION PROGRAM FOR CHINESE POPULATION WITH DEPRESSIVE DISORDERS—A RANDOMISED CONTROLLED TRIAL R.M.W. Chau 1 , R.M.K. Ng 2 , A.W.K. Tsang 2 , Z.H.S. Yu 3 , K.M. Ng 2 , M.M.Y. Lam 1 , S.W.C. Hui 4 , P.Y.K. Lo 1 , P.W.L. Lau 1 , P.M.Y. Lau 1 1 Kowloon
Hospital, Physiotherapy Department, Hong Kong, Hong Kong; 2 Kowloon Hospital, Department of Psychiatry, Hong Kong, Hong Kong; 3 Kwai Chung Hospital, Department of Psychiatry, Hong Kong, Hong Kong; 4 Kwai Chung Hospital, Physiotherapy Department, Hong Kong, Hong Kong Background: Exercise was reported to be effective in the management of depressive disorders among the western populations. However, studies demonstrated cultural differences in symptoms manifestation of depressive disorders between Chinese and western populations. There is a paucity of published studies on the benefits of exercises in the management of depressive disorders among Chinese population who demonstrated different pattern of symptoms manifestation with increased likelihood of somatization and avoidance in seeking medical assistance. Purpose: The aim of this study was to investigate the effectiveness of a structured Physical Rehabilitation Program on improving the physical fitness and negative psychological symptoms for Chinese population with depressive disorders. Methods: A single-blind, randomized controlled trial (RCT) was conducted in Chinese adults (age from 18 to 64) with depressive disorders. Subjects were recruited from two district hospitals during February 2012 to October 2013 with random allocation into: (1) intervention group with 60-minute structured Physical Rehabilitation Program, three times a week for 12 weeks; or (2) 12-week waitlist control group. Physical fitness outcome measures includes body fat percentage; sit-and-reach test to examine flexibility; one-minute sit-up count to assess muscular endurance; maximum handgrip and quadriceps power to measure muscle strength; maximal oxygen consumption (VO2max ) for cardiovascular endurance measurement. Mental outcome measures included Depression, Anxiety, Stress Scale (DASS-21) and Rosenberg self-esteem scale (RSES). All outcome measures were administered at baseline and 12 weeks follow-up by another independent physiotherapist who was blind to the alloca-
tion status of the participants. Two-way repeated measures ANOVA were used to investigate the effects of group and time. Independent-sample t test was performed to examine the between group difference and paired-samples t test was used to analyse the within group difference. Intention-to-treat analysis was used for missing data. Results: Eighty-four subjects (intervention n = 42, control n = 42) with mean age of 47.37 ± 10.61 completed the program. 16 subjects defaulted the program with comparable attrition rate as quoted in previous literatures. Baseline characteristics between two groups were comparable. Significant improvement in all domains was found in intervention group (all p < 0.05) while no significant change was found in control group after 12 weeks. For between-group comparison, intervention group demonstrated significant greater improvement when compared with control group in body fat percentage (28.07 ± 6.59% versus 33.54 ± 6.35%); sit-and-reach test (2.57 ± 10.15 cm versus −1.54 ± 8.61 cm); oneminute sit-up count (11.14 ± 9.50 versus 5.19 ± 6.04); maximum hand grip strength (29.63 ± 8.36 kgf versus 24.64 ± 6.72 kgf); quadriceps strength (29.54 ± 6.52 kgf versus 25.17 ± 8.08 kgf); VO2max (30.53 ± 5.18 ml/kg/min versus 24.94 ± 6.60 ml/kg/min); all three DASS-21 domains (depression: 13.19 ± 9.51 versus 21.86 ± 10.57; anxiety: 11.86 ± 7.55 versus 18.81 ± 10.58; stress: 16.86 ± 9.33 versus 23.36 ± 10.16) and RSES (28.45 ± 5.83 versus 24.79 ± 4.61). Conclusion(s): The results supported that a structured physical rehabilitation program was an effective intervention in improving the physical fitness and negative psychological symptoms for Chinese population with depressive disorders. Implications: A structured Physical Rehabilitation Program could be easily set up in physiotherapy department or prescribed as home program to benefit the Chinese population with mild to severe depressive disorders. The findings also supported the role of physiotherapy in the management of patients with depressive disorder. Keywords: Physical rehabilitation program; Chinese population; Depressive disorders Funding acknowledgements: The study was supported by the Kowloon Central Research Grant of Hospital Authority of Hong Kong R1002 (Ref. No. 1305). Ethics approval: Approval granted by the Research Ethics Committees of Hospital Authority of Hong Kong on 16 December 2011 (KC/KE-11-0189/ER-3). http://dx.doi.org/10.1016/j.physio.2015.03.387
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Research Report Platform Presentation Number: RR-PL-1770 Saturday 2 May 2015 11:51 Room 303–304 EFFECTIVENESS OF A STRUCTURED PHYSICAL REHABILITATION PROGRAM FOR CHINESE POPULATION WITH DEPRESSIVE DISORDERS—A RANDOMISED CONTROLLED TRIAL R.M.W. Chau 1 , R.M.K. Ng 2 , A.W.K. Tsang 2 , Z.H.S. Yu 3 , K.M. Ng 2 , M.M.Y. Lam 1 , S.W.C. Hui 4 , P.Y.K. Lo 1 , P.W.L. Lau 1 , P.M.Y. Lau 1 1 Kowloon
Hospital, Physiotherapy Department, Hong Kong, Hong Kong; 2 Kowloon Hospital, Department of Psychiatry, Hong Kong, Hong Kong; 3 Kwai Chung Hospital, Department of Psychiatry, Hong Kong, Hong Kong; 4 Kwai Chung Hospital, Physiotherapy Department, Hong Kong, Hong Kong Background: Exercise was reported to be effective in the management of depressive disorders among the western populations. However, studies demonstrated cultural differences in symptoms manifestation of depressive disorders between Chinese and western populations. There is a paucity of published studies on the benefits of exercises in the management of depressive disorders among Chinese population who demonstrated different pattern of symptoms manifestation with increased likelihood of somatization and avoidance in seeking medical assistance. Purpose: The aim of this study was to investigate the effectiveness of a structured Physical Rehabilitation Program on improving the physical fitness and negative psychological symptoms for Chinese population with depressive disorders. Methods: A single-blind, randomized controlled trial (RCT) was conducted in Chinese adults (age from 18 to 64) with depressive disorders. Subjects were recruited from two district hospitals during February 2012 to October 2013 with random allocation into: (1) intervention group with 60-minute structured Physical Rehabilitation Program, three times a week for 12 weeks; or (2) 12-week waitlist control group. Physical fitness outcome measures includes body fat percentage; sit-and-reach test to examine flexibility; one-minute sit-up count to assess muscular endurance; maximum handgrip and quadriceps power to measure muscle strength; maximal oxygen consumption (VO2max ) for cardiovascular endurance measurement. Mental outcome measures included Depression, Anxiety, Stress Scale (DASS-21) and Rosenberg self-esteem scale (RSES). All outcome measures were administered at baseline and 12 weeks follow-up by another independent physiotherapist who was blind to the alloca-
tion status of the participants. Two-way repeated measures ANOVA were used to investigate the effects of group and time. Independent-sample t test was performed to examine the between group difference and paired-samples t test was used to analyse the within group difference. Intention-to-treat analysis was used for missing data. Results: Eighty-four subjects (intervention n = 42, control n = 42) with mean age of 47.37 ± 10.61 completed the program. 16 subjects defaulted the program with comparable attrition rate as quoted in previous literatures. Baseline characteristics between two groups were comparable. Significant improvement in all domains was found in intervention group (all p < 0.05) while no significant change was found in control group after 12 weeks. For between-group comparison, intervention group demonstrated significant greater improvement when compared with control group in body fat percentage (28.07 ± 6.59% versus 33.54 ± 6.35%); sit-and-reach test (2.57 ± 10.15 cm versus −1.54 ± 8.61 cm); oneminute sit-up count (11.14 ± 9.50 versus 5.19 ± 6.04); maximum hand grip strength (29.63 ± 8.36 kgf versus 24.64 ± 6.72 kgf); quadriceps strength (29.54 ± 6.52 kgf versus 25.17 ± 8.08 kgf); VO2max (30.53 ± 5.18 ml/kg/min versus 24.94 ± 6.60 ml/kg/min); all three DASS-21 domains (depression: 13.19 ± 9.51 versus 21.86 ± 10.57; anxiety: 11.86 ± 7.55 versus 18.81 ± 10.58; stress: 16.86 ± 9.33 versus 23.36 ± 10.16) and RSES (28.45 ± 5.83 versus 24.79 ± 4.61). Conclusion(s): The results supported that a structured physical rehabilitation program was an effective intervention in improving the physical fitness and negative psychological symptoms for Chinese population with depressive disorders. Implications: A structured Physical Rehabilitation Program could be easily set up in physiotherapy department or prescribed as home program to benefit the Chinese population with mild to severe depressive disorders. The findings also supported the role of physiotherapy in the management of patients with depressive disorder. Keywords: Physical rehabilitation program; Chinese population; Depressive disorders Funding acknowledgements: The study was supported by the Kowloon Central Research Grant of Hospital Authority of Hong Kong R1002 (Ref. No. 1305). Ethics approval: Approval granted by the Research Ethics Committees of Hospital Authority of Hong Kong on 16 December 2011 (KC/KE-11-0189/ER-3). http://dx.doi.org/10.1016/j.physio.2015.03.387