The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD

Fiona A. H. M. Cleutjens*, Martijn A. Spruit, Rudolf W. H. M. Ponds, Lowie E. G. W. Vanfleteren, Frits M. E. Franssen, Jeanette B. Dijkstra, Candy Gijsen, Emiel F. M. Wouters, Daisy J. A. Janssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment.

Design: A cross-sectional observational study.

Setting: Patients with COPD were recruited from a PR centre in the Netherlands.

Participants: The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR.

Measurements: A comprehensive neuropsychological examination before start of PR was administered. Changes from baseline to PR completion in functional exercise capacity [ 6-minute walk test (6MWT)], disease-specific health status [COPD Assessment Test (CAT) and St George's Respiratory Questionnaire-COPD specific (SGRQ-C)], psychological well-being [Hospital Anxiety and Depression Scale (HADS)], COPD-related knowledge, and their need for information [Lung Information Needs Questionnaire (LINQ)] were compared between patients with and without cognitive impairment using independent samples t tests or Mann-Whitney U tests.

Results: Out of 157 patients with COPD [mean age 62.9 (9.4) years, forced expiratory volume in the first second 54.6% (22.9%) predicted], 24 patients (15.3%) did not complete PR. The dropout rate was worse in patients with cognitive impairment compared to those without cognitive impairment (23.3% and 10.3%, P = .03). Mean changes in PR outcomes after PR did not differ between completers with and without cognitive impairment. The proportion of patients with a clinically relevant improvement in 6MWT, CAT, SGRQ-C, HADS, and LINQ scores was comparable for patients with and without cognitive impairment.

Conclusion: PR is an effective treatment for patients with COPD and cognitive impairment. Yet patients with cognitive impairment are at increased risk for not completing the PR program. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Original languageEnglish
Pages (from-to)420-426
Number of pages7
JournalJournal of the American Medical Directors Association
Volume18
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • COPD
  • cognitive impairment
  • pulmonary rehabilitation
  • patient-related outcomes
  • CHRONIC RESPIRATORY-DISEASE
  • RANDOMIZED CONTROLLED-TRIAL
  • FIELD WALKING TESTS
  • OLDER-ADULTS
  • MEDICATION ADHERENCE
  • IMPORTANT DIFFERENCE
  • VALIDATION
  • DEPRESSION
  • DEMENTIA
  • PREDICTORS

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