The Effects of an Acceptance and Commitment-Informed Interdisciplinary Rehabilitation Program for Chronic Airway Diseases on Health Status and Psychological Symptoms.

Emanuele Maria Giusti,Barbara Papazian,Pietro Galli,Francesca Castelli,Valentina Giussani,Milena Perotti,Agnese Rossi,Chiara Manna,Silvia Battaglia,Valentina Re,Karine Goulene,Marco Stramba-Badiale,Gianluca Castelnuovo

doi:10.3389/fpsyg.2021.818659

Abstract

BackgroundChronic airway diseases are prevalent and costly conditions. Interdisciplinary rehabilitation programs that include Acceptance and Commitment-based (ACT) components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms.MethodsA retrospective evaluation of routinely collected data of an interdisciplinary rehabilitation program was performed. The program included group sessions including patient education, breathing exercise, occupational therapy and an ACT-based psychological treatment, and individual sessions of physical therapy. Demographic data, clinical characteristics of the patients and the values of outcome variables (health status, quality of life, anxiety, and depression) before treatment, at discharge, at 3 months, and at 6 months were extracted from medical records. Multiple imputation was employed to address missing data. Linear mixed models were employed to assess changes over time. Multivariable logistic regression was performed to assess predictors of a minimum clinically important change of health status from baseline to the 6-months follow-up.ResultsData from 31 patients with chronic obstructive pulmonary disease (COPD) and 12 patients with bronchiectasis were extracted. Health status improved from baseline to discharge to the 3 months follow-up, but not to the 6 months follow-up. Anxiety and depression improved across all the time points. Quality of life did not improve over time. Having a worse health status at baseline and fewer depressive symptoms were significantly associated with achieving a minimum clinically important change of health status at 6 months. The effects of the interdisciplinary program were not different for patients with COPD or with bronchiectasis.DiscussionInterdisciplinary programs including ACT-based components are promising treatments for the rehabilitation of patients with chronic airway diseases.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) and bronchiectasis are chronic airway diseases, mainly characterized by airflow limitation, frequent lung inflammation, presence of mucus and dyspnea (Celli et al, 2004)
We extracted routinely collected data from medical records of patients with COPD or bronchiectasis who were enrolled in an interdisciplinary rehabilitation program at the Rehabilitation Medicine Unit of the IRCCS Istituto Auxologico Italiano
Data were extracted from records of patients meeting the following inclusion criteria: (1) being enrolled in the interdisciplinary rehabilitation program, (2) having a medical diagnosis of COPD or bronchiectasis

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) and bronchiectasis are chronic airway diseases, mainly characterized by airflow limitation, frequent lung inflammation, presence of mucus and dyspnea (Celli et al, 2004). Mortality at 1-year follow-up after suffering an exacerbation of bronchiectasis is between 20 and 30%, which is higher if COPD is comorbid (Finklea et al, 2010; Goeminne et al, 2014). These conditions have a multifactorial genesis which includes genetic, environmental (e.g., exposure to pollution) and behavioral factors, in particular cigarette smoking. They mainly affect respiratory traits, they cause considerable consequences on other health domains, reducing patients’ quality of life (Athanazio, 2012). Interdisciplinary rehabilitation programs that include Acceptance and Commitmentbased (ACT) components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms

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