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- Engström, Carl-Peter, 1945, et al.
(författare)
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Health-related quality of life in COPD: why both disease-specific and generic measures should be used.
- 2001
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Ingår i: The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. - 0903-1936. ; 18:1, s. 69-76
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Tidskriftsartikel (refereegranskat)abstract
- Although research has consistently demonstrated that chronic obstructive pulmonary disease (COPD) impairs health-related quality of life (HRQL), little agreement has been evidenced regarding the factors identified as contributing to impaired HRQL. The aim was to study such factors using well established generic and specific HRQL instruments. The patients (n=68) were stratified by forced expiratory volume in one second (FEV1) to represent a wide range of disease severity. Pulmonary function, blood gases and 6-min walking distance test (6MWD) were assessed. HRQL instruments included: St George's Respiratory Questionnaire (SGRQ), Sickness Impact Profile (SIP), Hospital Anxiety and Depression Scale and Mood Adjective Check List. The strength of the impact of COPD on HRQL was represented along a continuum ranging from lung function, functional status (physical and psychosocial) to wellbeing. Although correlations between FEV1 versus SGRQ total and SIP overall scores (r=-0.42 and -0.32) were stronger than previously reported, multiple regression analyses showed that lung function contributed little to the variance when dyspnoea-related limitation, depression scores and 6MWD were included in the models. These three factors were important to varying degrees along the whole range of HRQL. Physiological, functional and psychosocial consequences of chronic obstructive pulmonary disease are only poorly to moderately related to each other. The present study concludes that a comprehensive assessment of the effects of chronic obstructive pulmonary disease requires a battery of instruments that not only tap the disease-specific effects, but also the overall burden of the disease on everyday functioning and emotional wellbeing.
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| 2. |
- Engström, Carl-Peter, 1945
(författare)
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Studies on health-related quality of life in patients with chronic obstructive pulmonary disease
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims. To describe health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD), to develop a Swedish version of the St George's Respiratory Questionnaire (SGRQ), to study factors related to HRQL in COPD and to study long-term effects of rehabilitation on exercise tolerance and HRQL.Methods. Two sets of data were collected to meet the research questions.A. Sixty-eight patients with COPD were consecutively recruited and stratified according to FEV1 to represent different levels of the disease. Spirometry and walking test were performed. A control group was recruited from the general population. HRQL was assessed with the Sickness Impact Profile (SIP), the Hospital Anxiety and Depression scale (HAD), the Mood Adjective Check List (MACL) and (patients only) the SGRQ. B. Patients with COPD were consecutively recruited to a randomized controlled study of a multidisciplinary rehabilitation programme (n=26). Controls (n=24) were treated conventionally. Exercise tolerance and HRQL were measured.Results. Major findings were presented in four articles:A1. Compared with controls, patients with COPD scored worse on all the SIP categories except alertness behaviour and communication. The worst dysfunction reported on the SIP were: ambulation, sleep/rest, eating, home management and recreation/pastimes. These differences were noted mainly in patients with an FEV1 < 50% predicted. Physical functioning was most severely affected followed by psychosocial functioning and then emotional well-being. A 2. An established disease-specific questionnaire, the SGRQ, was adapted to Swedish according to a standardized translation and psychometric analysis procedure. Validity was confirmed as the correlation pattern was almost identical to that reported for the original version. Reliability was satisfactory with Cronbach's alpha coefficient > 0.80 for all three SGRQ sections, although overlap of content was seen in two.A 3. The SIP and SGRQ scores showed substantial associations to walking distance and affective measures but modest to pulmonary function. Stepwise multiple regression demonstrated three factors of overriding importance for the full range of generic and specific HRQL measures: dyspnoea-related restriction, exercise tolerance (walking distance), and level of depressed mood (HAD).B. After 12 months the rehabilitation group showed an improved exercise capacity (walking distance and maximal exercise capacity). In contrast, no statistically significant improvement in HRQL was seen. Conclusions. Five major conclusions were drawn: 1) All aspects of HRQL are affected by COPD when pulmonary function (FEV1) is reduced by 50% or more; 2) Physical functioning is most severely affected; 3) Dyspnoea-related restriction, exercise tolerance (walking distance) and level of depressed mood (HAD) are consistent determinants of the full range of HRQL measures; 4) Impacts of COPD can be detected also in Swedish patients by the validated version of the SGRQ; 5) A rehabilitation programme for COPD patients has positive long-term effects on exercise tolerance.
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| 3. |
- Slinde, Frode, 1973, et al.
(författare)
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Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation
- 2002
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Ingår i: Respir Med. ; 96:5, s. 330-6
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Tidskriftsartikel (refereegranskat)abstract
- Dietary intervention studies in COPD patients often are short-term inpatient studies where a certain amount of extra energy is guaranteed. The aim of this study was to evaluate the effect of an 1 year individual multifaceted dietary intervention during multidisciplinary rehabilitation. Eighty-seven patients with severe COPD, not demanding oxygen therapy were included, 24 of them served as controls. A dietary history interview was performed at baseline and at study end. Dietary advice given were based on results from the dietary history and socio-economic status. The intervention group was divided into three parts; NW: normal weight (dietary advice given aiming to weight maintenance), OW: overweight (weight-reducing advice) and UW: underweight (dietary advise based on an energy- and protein-rich diet). RESULTS: UW-group: Eighty-one per cent of the patients gained weight or kept a stable weight. OW-group: Fifty-seven per cent lost more than 2 kg NW-group: Seventy-six per cent kept a stable weight or gained weight. Increased dietary intake from baseline was seen for energy protein, carbohydrates and certain micronutrients (P < 0.05) in the UW group. Six minutes walking distance increased by approximately 20 m in both NW (P < 0.05) and UW patients. To conclude, slight, but uniform, indications of positive effects of dietary intervention during multidisciplinary rehabilitation was seen. Dietary intervention in underweight COPD patients might be a prerequisite for physical training.
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