The Effect Of Pulmonary Rehabilitation Of Different Stage On Chronic Obstructive Pulmonary Disease Patients With Acute Exacerbation

Objectives(1) Compare the anxiety and depression degree of patients with COPD acuteexacerbations and patients who were in COPD stable stage;(2) Explore the influencing factors for anxiety, depression of patients with COPD acuteexacerbation;(3) Compare patients’ pulmonary rehabilitation compliance between the acuteexacerbation rehabilitation group and the stable rehabilitation group;(4) Explore the effect of acute exacerbation rehabilitation on COPD patients;(5) Compare the effect of acute exacerbation rehabilitation and stable rehabilitation onCOPD patients with acute exacerbations.Methods(1)While the infection had been controlled and the acute exacerbation symptoms hadimproved significantly after the treatment (usually before discharge), baseline data wereassessed, which including demographic characteristics, anxiety score (STAI), depressionscore (BDI), dyspnea (MRC), the quality of life (SGRQ), exercise capacity (6MWT) andpulmonary function.(2) After baseline assessment, patients were randomized to acute exacerbationrehabilitation group or stable rehabilitation group. Acute exacerbation rehabilitation groupstarted pulmonary rehabilitation when the infection had been controlled and acuteexacerbation symptoms had been improved significantly, the stable rehabilitation groupstarted pulmonary rehabilitation at the end of8weeks after the treatment of acute exacerbation. Before the stable rehabilitation group starting rehabilitation, the secondassessment was done (variables are the same as baseline assessment). The effect ofpulmonary rehabilitation was assessed at the end of8weeks of pulmonary rehabilitationamong those patients whose compliance to pulmonary rehabilitation was good.(3) Pulmonary rehabilitation program: This was a pulmonary rehabilitation program with8weeks at home, including walking exercises3times every week,60minutes each time;breathing exercises three times every day,10minutes each time, or30minutes each time,once per day. During the8weeks pulmonary rehabilitation, patients should recordrehabilitation diary, and the researchers followed up at outpatient and by telephone.Estimate and compare patients’ pulmonary rehabilitation compliance according to thepulmonary rehabilitation diary and follow-up.(4) The material was analyzed by SPSS16.0, the statistics methods were as followed:descriptive analysis, Multiple linear regression analysis, Wilcoxon signed rank test, t tset,U test and x2test.Results1. The level and influening factors of anxiety and depressionOn the baseline assessment,124patients with COPD acute exacerbations, the averagestate anxiety score was40.15±10.97,28patients were state anxiety positive(22.6%); theaverage trait anxiety score was42.96±10.00,31patients were trait anxietypositive(25.0%); the average depression score was7.23±5.72, including73patients werepositive (58.9%). The state anxiety, trait anxiety, and depression scores of COPD patientswith acute exacerbation and stable stage were38.98±9.83VS34.92±8.18,42.05±9.41VS36.95±7.72,6.35±5.04VS3.98±2.68respectively, in which significant differenceswere observed in the two stage (P <0.05). The morbidity of state anxiety, trait anxiety anddepression respectively were15.0%,22.5%,50.0%among the COPD patients with acuteexacerbation, and respectively were5.0%,7.5%and30.0%among the COPD patients instable stage, there were no significant difference between the two stages (P>0.05).Dyspnea played an important role on state anxiety and trait anxiety (P <0.001),depression was influenced mainly by dyspnea, smoking and exercise capacity (P <0.05). 2. The compliance between two groups of pulmonary rehabilitationStable rehabilitation group had significant more time and number, higher scores of timecompliance and number compliance in walking exercise, breathing exercises and totalrehabilitation than acute exacerbation rehabilitation,respectively (P <0.05); Stablerehabilitation group had significant higher percentage of good compliance of time andnumber in walking exercise, breathing exercises and total rehabilitation (P <0.05).3. The effect of acute exacerbation rehabilitation on COPD patients3.1The effect of acute exacerbation rehabilitation on anxiety and depressionState anxiety,trait anxiety and depression scores before and after the acute exacerbationrehabilitation were39.31±10.90VS31.65±7.45,41.69±10.07VS33.85±7.64,6.42±4.73VS2.77±2.03,all of them were reduced significantly (P <0.001). The scores ofstate anxiety,trait anxiety and depression before and after8weeeks in control group were38.60±9.28VS35.66±8.37,42.29±8.67VS37.86±7.85,6.29±4.88VS4.54±2.93,which were also significantly fall down (P <0.01). And compared to the control group,the scores of state anxiety,trait anxiety and depression after acute exacerbationrehabilitation decline with7.65±7.10,7.85±6.06and3.65±3.85. While control groupwere:2.94±4.97,4.43±4.77and1.74±2.64, which showed the value of state anxiety andtrait anxiety in the acute exacerbation rehabilitation group down significantly greater thanthe control group (P <0.05).3.2The effect of acute exacerbation rehabilitation on dyspneaThe dyspnea scores before and after acute exacerbation rehabilitation were3.19±0.80and2.31±0.97, both significant difference (P <0.001); Before and after8weeks in controlgroup were3.00±1.14and2.71±0.86, which were not statistically significant (P=0.065).The value of dyspnea score after acute exacerbation rehabilitation was down with-0.88±0.86,which was significantly greater than control group,as-0.29±0.89(P=0.014).3.3The effect of acute exacerbation rehabilitation on exercise capacityThe six minutes walking distance before and after acute exacerbation rehabilitation were303.81±100.00and361.95±89.97meters, both had significant difference (P <0.001); Before and after eight weeks in the control group,the six minutes walking distance were305.60±120.71and333.44±121.15meters, both also have significant difference (P=0.014). But the value of six minutes walking distance of acute exacerbation rehabilitationgroups added58.14±66.01meters, much higher than the27.04±61.83meters of controlgroup (P=0.001).3.4The effect of acute exacerbation rehabilitation on quality of lifeThe quality of life scores of SGRQ total, SGRQ symptoms, SGRQ activity and SGRQinfluence parts before and after acute exacerbation rehabilitation were62.96±16.13VS46.20±16.21,69.12±15.97VS54.04±14.16,81.19±19.43VS60.85±17.51and51.19±19.53VS33.35±16.46, had significant difference respectively (P <0.001); Before andafter eight weeks in the control group,the scores of SGRQ total, SGRQ symptoms,SGRQ activity and SGRQ influence were56.09±20.57VS48.58±12.71,66.14±18.46VS59.57±15.40,68.83±26.97VS57.23±17.34, and46.94±20.53VS41.80±14.54. Thescores of SGRQ total, SGRQ symptoms and SGRQ activity before and after haddifference (P <0.05). The scores of SGRQ total, SGRQ symptoms, SGRQ activity andSGRQ influence of the acute exacerbation rehabilitation group were down, respectivelywith16.77±17.03,15.08±14.48,20.53±16.66and17.85±19.28, control groupseparately with7.51±13.46,6.57±16.22,11.60±15.19and5.14±15.87, The value ofacute exacerbation rehabilitation group of SGRQ symptom and SGRQ influence scorewere higher than the control group (P <0.05).3.5The effect of acute exacerbation rehabilitation on lung functionFVC%, FVC, FEV1and FEV1%before and after acute phase rehabilitation were1.94±0.62L VS1.95±0.60L,60.40±15.58VS58.16±13.80,0.76±0.27L VS0.77±0.26Land31.15±11.17VS31.35±10.90(P>0.05); Before and after eight weeks in controlgroup were2.10±0.59L VS2.08±0.56L,65.71±17.47VS65.29±16.62,9.05±3.39L VS9.23±3.40L, and36.51±15.27VS37.31±15.42(P>0.05). The change value of FVC,FVC%, FEV1and FEV1%in acute exacerbation rehabilitation were0.01±0.34L,2.24±10.41,0.01±0.09L and0.19±3.17, and control group respectively were0.02±0.09L,0.38±1.60,0.01±0.13L and0.07±5.56, two groups had no significant difference (P> 0.05).4The effect of pulmonary rehabilitation of different stage on COPD patients withacute exacerbation4.1The effect of pulmonary rehabilitation of different stage on anxiety anddepressionThe scores of state anxiety,trait anxiety and depression are down significantly aroundCOPD patients in the acute exacerbation rehabilitation group (P <0.001); compared to thebaseline assessment，the scores also down significantly after stable rehabilitation (P <0.001), which were36.80±10.00VS33.40±7.74,40.05±9.01VS35.70±7.26,5.50±5.15VS4.15±3.08. The change value of scores of state anxiety, trait anxiety anddepression in acute exacerbation rehabilitation group were7.65±7.10,7.85±6.06and3.65±3.85, and stable rehabilitation groups were3.40±3.75,4.35±3.48and1.35±2.92,The acute exacerbation rehabilitation group were significantly greater than the stablerehabilitation group (P <0.05).4.2The effect of pulmonary rehabilitation of different stage on dyspneaThe dyspnea score down significantly among COPD patients in the acute exacerbationrehabilitation group (P <0.001); the dyspnea score before and after stable rehabilitationgroup were2.70±1.08and2.30±0.57, both were statistically different (P=0.033). Thechange value of dyspnea score in the acute exacerbation rehabilitation group with-0.88±0.86，more than stable rehabilitation group with-0.40±0.75, but had no statisticalsignificance (P=0.081).4.3The effect of pulmonary rehabilitation of different stage on exercise capacityThe six minutes walk distance was significant among COPD patients before and after theacute exacerbation rehabilitation (P <0.001). The six minutes walk distance before andafter Stable rehabilitation were368.08±96.37and388.55±82.89meters, which shows asignificant difference (P=0.013). The six minutes walking distance of acute exacerbationrehabilitation increase with58.14±66.01meters, much higher than the20.46±33.56meters of stable rehabilitation group (P=0.025). 4.4The effect of pulmonary rehabilitation of different stage on the quality of lifeThe score of SGRQ total, SGRQ symptoms, SGRQ activity and SGRQ influence beforeand after acute exacerbation rehabilitation were significantly changed (P <0.001); Thescore of SGRQ total, SGRQ symptoms, SGRQ activity and SGRQ influence before andafter stable rehabilitation were49.75±22.17VS43.82±16.75,63.20±19.79VS57.30±18.75,59.70±26.32VS52.10±18.95,40.55±23.29VS34.75±16.36, includingSGRQ activity and SGRQ total score were significant difference (P=0.015, P=0.049).After acute exacerbation rehabilitation，the score of SGRQ total, SGRQ symptoms, SGRQactivities and SGRQ influence wre down respectively with16.77±17.03,15.08±14.48,20.53±16.66and17.85±19.28, were significantly greater than the5.93±12.68,5.90±14.30,7.60±12.73and5.80±13.80in the stable rehabilitation group (P <0.05).4.5The effect of pulmonary rehabilitation of different stage on lung functionFVC%, FVC, FEV1and FEV1%before and after acute exacerbation rehabilitationshowed no significant improvement (P>0.05); FVC%, FVC, FEV1and FEV1%beforeand after stable rehabilitation were2.14±0.63L VS2.20±0.55L,68.02±17.69VS69.15±17.37,0.93±0.33L VS0.96±0.30L,38.30±16.43VS39.32±15.72, which were nosignificant difference between two groups(P>0.05). The change of FVC%, FVC, FEV1and FEV1%in acute exacerbation rehabilitation group were0.01±0.34L,2.24±10.41,0.01±0.09L and0.19±3.17, and the stable rehabilitation group were0.061±0.28L,1.14±8.37,0.04±0.10L and1.02±2.67,which were no significant difference (P>0.05).Conclusions1. The COPD patients had a high rate of positive depression and anxiety in the acuteexacerbation stage, which were higher than in stable stage.2. Dyspnea played an important role on anxiety. Depression was influenced mainly bydyspnea, exercise capacity and smoking years.3. The rehabilitation compliance of COPD patients with acute exacerbation was poorerthan those in stable stage.4. Acute exacerbation rehabilitation could improve the anxiety and depression of COPDpatients with acute exacerbations, as well as reduce dyspnea, improve the quality of life and exercise capacity.5. The effect of acute exacerbation rehabilitation was better than the stable rehabilitation.