IMPACT OF PSYCHOLOGICAL FACTORS ON FUNCTIONAL PERFORMANCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

M. Aldhahi¹, B. Baattaiah², A. Albarrati³, R. Nazer⁴

¹Princess Nourah bint Abdulrahman University, Rehabilitation Sciences, Riyadh, Saudi Arabia, ²King Abdulaziz University, Department of Physical Therapy, Jeddah, Saudi Arabia, ³King Saud University, Rehabilitation Sciences Department, Riyadh, Saudi Arabia, ⁴King Saud University, Cardiac Sciences Department, Riyadh, Saudi Arabia

Background: Patients with COPD are prone to mental changes secondary to disease-related symptoms. However, the effect of psychological factors, including anxiety and depression, on functional performance in patients with chronic obstructive pulmonary disease (COPD) is controversial.

Purpose: We aim to characterize the functional performance during walking, psychological factors (anxiety and depression), and health status of groups of COPD with or without anxiety. Furthermore, the study aims to examine the association of psychological factors and health status with walking performance.

Methods: In this cross-sectional study, a total of 70 stable patients diagnosed with COPD participated in the study. Pulmonary function was assessed using Spirometry (Vitalograph Alpha machine). Patients underwent a six-minute walk test (6 MWT) to evaluate their functional performance. Anxiety and depression assessments were assessed using the Anxiety Inventory for Respiratory Disease (AIR) and the Hospital anxiety and depression scale (HADS), respectively. Patients with COPD completed the St. George’s respiratory questionnaire (SGRQ) to assess health-related quality status. Anxiety and depression were defined if the patients scored >8 on the AIR and HADS-depression subscale, respectively. A forward multiple linear regression analysis was used to assess the association between the independent variables and 6 MWT as a dependent variable.

Results: Most patients were men (84.21%), with a mean (±SD) age of 63.2 ±11 years. Nearly half of Patients with COPD (46 %) were anxious, and 49% had higher depression scores. Based on the GOLD criteria for COPD severity, the majority of the patients (36 [51.43%]) had moderate COPD as the predicated FVC1 was 63.98 ± 7.5 L. The anxiety group had high AIR (12.78± 4.07) and HADS-depression (9.90 ± 3.41) compared to the non-anxietyp<.001. The total HADS was higher in the anxiety group (20.87±6.13) compared to the non-anxiety group (9.26 ± 4.72),p<.001.
There were no significant differences in the pulmonary function profile or the smoking status between anxious and non-anxious patients with COPD. Patients with high anxiety had low functional performance (6MWT=308.75 ± 120.16 m) and poor HRQOL (SGRQ=56.54 ± 22.36) compared to the non-anxiety group (6MWT=373.76 ± 106.56m and SGRQ = 42.90 ± 24.76), p <.01). The walking distance had a negative correlation with the depression (r= -.37), anxiety (r= -.38) and the health status (r=-.42). Multiple linear Regression analysis showed that psychological factors contributed by 32% in the variability of functional performance after controlling for severity of the COPD (R²=.33; F [4, 6] = 7.68, p=.03).

Conclusions: Patients with COPD had greater levels of anxiety and depression. Patients with COPD with high levels of anxiety and depression were physically impaired and had low HRQOL. Psychosocial status contributed to low functional performance and HRQOL independent of lung severity.

Implications: The study highlights the need to screen patients with COPD at all stages for anxiety and depression. The changes in psychosocial status are shown to contribute significantly to the patient's physical performance.

Funding acknowledgements: This research received no specific grant from any funding agency.

Keywords:
Anxiety
Depression
Exercise intolerance

Topics:
Cardiorespiratory
Disability & rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: King Saud University Medical City and King Fahad Medical City

Committee: Institutional Review Board of King Saud University

Ethics number: KSU-IRB-017E