- Email: [email protected]
Importance of patient's perception in COPD assessment
378
Abstracts / Biological Psychology 129 (2017) 370–385
toms, is vitally important to slow overall declines in functioning and improve patients’ quality of life. The present study sought to develop a reliable and valid measure of perceived triggers of exacerbations in patients with COPD, the COPD Exacerbation Trigger Inventory (CETI), as well as examine how patient perceptions of controllability of such triggers relates to overall quality of life and disease status. Methods: Participants (n = 192) were recruited through local clinics and online to complete surveys of the CETI, demographic information, disease specific information including medications and comorbidities, and the COPD Assessment Test (CAT). The CETI included a free response section on patients’ individual top triggers, combined with ratings of their controllability. Results: Exploratory fixed factor analyses identified a stable 5-factor structure (6–7 items each) that demonstrated excellent internal consistency (Cronbach’s alpha = .90–.94). Such factors were found to be predictive of health status, exacerbation frequency, emergency room visits, and healthcare utilization. Participants found triggers related to dust, air pollution, smoking, and physical activity to be the most easily controlled, whereas those related to psychological factors, climate, infection, respiratory symptoms and sleep to be more difficult to control. Greater perceived controllability of triggers was associated with lower CAT scores, indicating higher overall quality of life and less impact of the disease on functioning. Discussion: Overall, the results of the present study indicate that the CETI is a reliable and valid measure of perceived exacerbation triggers in patients with COPD. Such perceptions of trigger types and controllability may prove useful in both research and clinical settings with this population and contribute to increased knowledge regarding patient care and treatment. Future research should continue to explore the associations between perceptions of exacerbation triggers and other clinical indicators of COPD, as well as how such perceptions might influence patients’ physical health and overall quality of life. http://dx.doi.org/10.1016/j.biopsycho.2017.08.028 The impact of loneliness during pulmonary rehabilitation in patients with COPD Thomas Reijnders 1,∗ , Konrad Schultz 2 , Sibylle Petersen 1,3 , Andreas von Leupoldt 1 1
Health Psychology, University of Leuven, Leuven, Belgium 2 Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany 3 Research Unit INSIDE, University of Luxembourg, Walferdange, Luxembourg Background: Psychological factors such as negative affect have been demonstrated to impact course and treatment of chronic obstructive pulmonary disease (COPD). However, little is known about the respective impact of social factors. Subjectively experienced loneliness has been shown to predict morbidity in several other chronic diseases, but little is known on its impact on COPD. Moreover, the associations of loneliness with disease-specific fears in COPD are unknown. Therefore, this study firstly examined the associations between loneliness and outcome measures of a pulmonary rehabilitation program (PR) as well as disease-specific fears. Methods: Before and after a 3-week inpatient PR program, patients with COPD (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Loneliness was assessed
with the Loneliness Scale. In addition, the Medical Outcomes Study 36-item short form and the COPD Anxiety Questionnaire were administered as measures of health-related quality of life (QoL) and disease-specific fears. Results: Multiple regression analyses showed that at the start of PR, higher levels of loneliness were associated with worse levels of functional exercise capacity and QoL, and more fear of physical activity and fear of disease progression, even after controlling for the effects of age, sex, lung function, and smoking status. Interestingly, patients who reported a stronger decrease in loneliness from start to end of PR showed greater improvement in functional exercise capacity and QoL, and a stronger decrease in fear of physical activity and fear of disease progression during PR. Discussion: This study shows that subjective loneliness is associated with relevant treatment outcomes and disease-specific fears in patients with COPD. Therefore, loneliness should be subject to further study as it could play a significant role in disease progression in patients with COPD. http://dx.doi.org/10.1016/j.biopsycho.2017.08.029 Importance of patient’s perception in COPD assessment Jose Luis Lopez-Campos Universidad de Sevilla, Spain Background: Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous disease, in which several factors interplay to give the final clinical expression. As a chronic respiratory condition, it has traditionally been considered an inexorably progressive airflow obstruction in terms of forced expiratory volume in 1 s (FEV1 ) deterioration. This worsening in FEV1 has been described as constantly progressing, only intermittently interrupted by exacerbations, and associated with an increase of symptoms in a parallel fashion. However, this paradigm has been recently challenged by the available evidence. First, the progression of the lung function deterioration is not as clear as previously described with some patients not declining FEV1 or even improving lung function. Second, recent studies have pointed out that COPD-related symptoms are not consistently perceived by patients in the same way, showing not only seasonal variation, but also changes in symptom perception during a week or even within a single day and with no obvious relationship with FEV1 . Accordingly, several studies have shown that FEV1 , despite being an extremely important parameter to predict the progression of the disease, is a poor surrogate marker for symptoms perception. Patient-reported outcomes (PROs) have gained popularity as a measure of the impact of treatment from the patients’ perspective, since they represent the individuals’ perception of their health status, beyond any physiological limitations. Several such PROs, therefore, are currently included in multidimensional COPD evaluation. This multidimensional approach helps identify different patient types and individualize pharmacological treatment. During the conference, we will be reviewing the evidence on symptoms perception and its variability in COPD and how to use this clinical expression for a personalised care. http://dx.doi.org/10.1016/j.biopsycho.2017.08.030
Abstracts / Biological Psychology 129 (2017) 370–385
toms, is vitally important to slow overall declines in functioning and improve patients’ quality of life. The present study sought to develop a reliable and valid measure of perceived triggers of exacerbations in patients with COPD, the COPD Exacerbation Trigger Inventory (CETI), as well as examine how patient perceptions of controllability of such triggers relates to overall quality of life and disease status. Methods: Participants (n = 192) were recruited through local clinics and online to complete surveys of the CETI, demographic information, disease specific information including medications and comorbidities, and the COPD Assessment Test (CAT). The CETI included a free response section on patients’ individual top triggers, combined with ratings of their controllability. Results: Exploratory fixed factor analyses identified a stable 5-factor structure (6–7 items each) that demonstrated excellent internal consistency (Cronbach’s alpha = .90–.94). Such factors were found to be predictive of health status, exacerbation frequency, emergency room visits, and healthcare utilization. Participants found triggers related to dust, air pollution, smoking, and physical activity to be the most easily controlled, whereas those related to psychological factors, climate, infection, respiratory symptoms and sleep to be more difficult to control. Greater perceived controllability of triggers was associated with lower CAT scores, indicating higher overall quality of life and less impact of the disease on functioning. Discussion: Overall, the results of the present study indicate that the CETI is a reliable and valid measure of perceived exacerbation triggers in patients with COPD. Such perceptions of trigger types and controllability may prove useful in both research and clinical settings with this population and contribute to increased knowledge regarding patient care and treatment. Future research should continue to explore the associations between perceptions of exacerbation triggers and other clinical indicators of COPD, as well as how such perceptions might influence patients’ physical health and overall quality of life. http://dx.doi.org/10.1016/j.biopsycho.2017.08.028 The impact of loneliness during pulmonary rehabilitation in patients with COPD Thomas Reijnders 1,∗ , Konrad Schultz 2 , Sibylle Petersen 1,3 , Andreas von Leupoldt 1 1
Health Psychology, University of Leuven, Leuven, Belgium 2 Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany 3 Research Unit INSIDE, University of Luxembourg, Walferdange, Luxembourg Background: Psychological factors such as negative affect have been demonstrated to impact course and treatment of chronic obstructive pulmonary disease (COPD). However, little is known about the respective impact of social factors. Subjectively experienced loneliness has been shown to predict morbidity in several other chronic diseases, but little is known on its impact on COPD. Moreover, the associations of loneliness with disease-specific fears in COPD are unknown. Therefore, this study firstly examined the associations between loneliness and outcome measures of a pulmonary rehabilitation program (PR) as well as disease-specific fears. Methods: Before and after a 3-week inpatient PR program, patients with COPD (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Loneliness was assessed
with the Loneliness Scale. In addition, the Medical Outcomes Study 36-item short form and the COPD Anxiety Questionnaire were administered as measures of health-related quality of life (QoL) and disease-specific fears. Results: Multiple regression analyses showed that at the start of PR, higher levels of loneliness were associated with worse levels of functional exercise capacity and QoL, and more fear of physical activity and fear of disease progression, even after controlling for the effects of age, sex, lung function, and smoking status. Interestingly, patients who reported a stronger decrease in loneliness from start to end of PR showed greater improvement in functional exercise capacity and QoL, and a stronger decrease in fear of physical activity and fear of disease progression during PR. Discussion: This study shows that subjective loneliness is associated with relevant treatment outcomes and disease-specific fears in patients with COPD. Therefore, loneliness should be subject to further study as it could play a significant role in disease progression in patients with COPD. http://dx.doi.org/10.1016/j.biopsycho.2017.08.029 Importance of patient’s perception in COPD assessment Jose Luis Lopez-Campos Universidad de Sevilla, Spain Background: Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous disease, in which several factors interplay to give the final clinical expression. As a chronic respiratory condition, it has traditionally been considered an inexorably progressive airflow obstruction in terms of forced expiratory volume in 1 s (FEV1 ) deterioration. This worsening in FEV1 has been described as constantly progressing, only intermittently interrupted by exacerbations, and associated with an increase of symptoms in a parallel fashion. However, this paradigm has been recently challenged by the available evidence. First, the progression of the lung function deterioration is not as clear as previously described with some patients not declining FEV1 or even improving lung function. Second, recent studies have pointed out that COPD-related symptoms are not consistently perceived by patients in the same way, showing not only seasonal variation, but also changes in symptom perception during a week or even within a single day and with no obvious relationship with FEV1 . Accordingly, several studies have shown that FEV1 , despite being an extremely important parameter to predict the progression of the disease, is a poor surrogate marker for symptoms perception. Patient-reported outcomes (PROs) have gained popularity as a measure of the impact of treatment from the patients’ perspective, since they represent the individuals’ perception of their health status, beyond any physiological limitations. Several such PROs, therefore, are currently included in multidimensional COPD evaluation. This multidimensional approach helps identify different patient types and individualize pharmacological treatment. During the conference, we will be reviewing the evidence on symptoms perception and its variability in COPD and how to use this clinical expression for a personalised care. http://dx.doi.org/10.1016/j.biopsycho.2017.08.030