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

doi:10.1016/j.jamda.2016.11.016

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 journal › Article › Academic › peer-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 language	English
Pages (from-to)	420-426
Number of pages	7
Journal	Journal of the American Medical Directors Association
Volume	18
Issue number	5
DOIs	https://doi.org/10.1016/j.jamda.2016.11.016
Publication status	Published - 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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10.1016/j.jamda.2016.11.016

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Cleutjens, F. A. H. M., Spruit, M. A., Ponds, R. W. H. M., Vanfleteren, L. E. G. W., Franssen, F. M. E., Dijkstra, J. B., Gijsen, C., Wouters, E. F. M., & Janssen, D. J. A. (2017). The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD. Journal of the American Medical Directors Association, 18(5), 420-426. https://doi.org/10.1016/j.jamda.2016.11.016

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title = "The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD",

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.",

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

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doi = "10.1016/j.jamda.2016.11.016",

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T1 - The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD

AU - Cleutjens, Fiona A. H. M.

AU - Spruit, Martijn A.

AU - Ponds, Rudolf W. H. M.

AU - Vanfleteren, Lowie E. G. W.

AU - Franssen, Frits M. E.

AU - Dijkstra, Jeanette B.

AU - Gijsen, Candy

AU - Wouters, Emiel F. M.

AU - Janssen, Daisy J. A.

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N2 - 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.

AB - 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.

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KW - pulmonary rehabilitation

KW - patient-related outcomes

KW - CHRONIC RESPIRATORY-DISEASE

KW - RANDOMIZED CONTROLLED-TRIAL

KW - FIELD WALKING TESTS

KW - OLDER-ADULTS

KW - MEDICATION ADHERENCE

KW - IMPORTANT DIFFERENCE

KW - VALIDATION

KW - DEPRESSION

KW - DEMENTIA

KW - PREDICTORS

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DO - 10.1016/j.jamda.2016.11.016

M3 - Article

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SN - 1525-8610

VL - 18

SP - 420

EP - 426

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 5

ER -

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

Abstract

Keywords

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