Perceived health status and quality of life : measurements and changes after a short inpatient rehabilitation programme for female and male COPD patients
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AbstractPerceived health status (HS) and quality of life (QoL) are regularly used as outcome variables to evaluate the effect of various treatments for patients with chronic obstructive pulmonary disease (COPD). Disease-specific HS questionnaires for patients with COPD quantify the impact of disease on patients’ daily life, health and well-being, and they usually include items that address both physical and psychological aspects. Application of the term quality of life often seems to be inconsistent, but there is some consensus that QoL should probably be reserved for scales where the items refer to life experiences but not in the context of disease. QoL is a broader concept than HS and includes factors such as social and psychological well-being and satisfaction with life, factors that may or may not be influenced by health or treatment. Factors that are closely related to health conditions – easily captured by disease-specific instruments – do not necessarily affect general QoL very much. Conversely, factors that are not health-related, and thus missed by disease-specific instruments, can make a significant difference in the assessment of general QoL.
The first aim of the thesis was to examine the associations between HS, QoL and physical function among COPD patients. Our results indicated that in order to achieve a comprehensive assessment, both total scores and subscores of HS and QoL instruments should be included to evaluate the impact of COPD on a person’s life and to measure the effects of pulmonary rehabilitation. Furthermore, it can be important to distinguish between variables related to physical functioning and variables related to psychological well-being.
COPD can have a substantial effect on the physical, emotional and social aspects of patients’ lives. Activities of daily living are often considerably impeded and many COPD patients suffer from emotional problems such as anxiety and depression. HS instruments, QoL instruments and physical indicators – e.g. spirometric values or walking tests – can show how patients’ lives are affected by COPD. Furthermore, they can be useful in order to evaluate effects of a pulmonary rehabilitation programme (PRP). Beneficial outcomes of PRPs are well documented and previous research has indicated that rehabilitation can enhance patients’ exercise capacity, HS, QoL and well-being. The magnitude of improvements, however, has varied considerably, both for physical tests and self-reported outcome variables. Also, improvements in emotional well-being and QoL have tended to be weaker and less consistent than improvements in HS.
The second aim of the thesis was to assess short-term and longitudinal changes in HS and QoL after a pulmonary rehabilitation programme for a sample of female and male COPD patients, as compared to a sample of asthma patients referred to the same PRP.
A short inpatient PRP was followed by immediate positive changes on HS, QoL and exercise capacity for the sample of COPD patients. Significant improvements were observed for variables related to physical functioning; emotionally related variables changed considerably less, although in a positive direction. Surprisingly, changes in exercise capacity did not co-vary with changes in physically related HS or QoL variables. The PRP appeared to have similar effects for female and male COPD patients. In contrast to an asthma sample, however, most of the gains in HS and QoL for the COPD sample had vanished at six months follow-up.
List of papers
|1. Haave E, Hyland ME & Engvik H.: Physical and emotional aspects of self-reported health status. A two-factor model of the short-form Breathing Problems Questionnaire. Chronic Respiratory disease 2005; 2(4):21-26.|
|2. Haave E, Hyland ME & Skumlien S.: The relation between measures of health status and quality of life in COPD. Chronic Respiratory disease 2006; 3(4):195-199.|
|3. Haave E, Hyland ME &Engvik H.: Improvements in exercise capacity during a 4 weeks pulmonary rehabilitation program for COPD patients do not correspond with improvements in self-reported health status or quality of life. International Journal of COPD 2007; 2(4).|
|4. Haave E, Skumlien S & Hyland ME.: Gender considerations in pulmonary rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention (in press)|
|5. Haave E & Hyland ME.: Different short-term and longitudinal results on perceived health status for asthma and COPD patients after pulmonary rehabilitation. Patients living alone have the largest improvements in perceived quality of life. Chronic Respiratory disease (in press)|