Evaluation of patients with severe pulmonary disease before and after pulmonary rehabilitation

Purpose: The purpose was to evaluate the impact of inpatient pulmonary rehabilitation program upon changes in anxiety, depression, psychological outlook, and dyspnea. A secondary purpose was to predict changes in psychological outlook, depression, anxiety, and dyspnea by using three pulmonary function tests and age. Methods: The design consisted of an observational study with pre - post comparisons. Forty-five patients with severe pulmonary disease, mean age 67.4 years (SD 9.2), mean FEV1= 31.44% predicted, 13 men, 32 women were compared on four measures before and after 3 weeks of rehabilitation. Measures were Beck Depression Inventory, Hamilton Anxiety Scale, Goldberg Scale, and Modified Borg Scale. In addition, a linear multiple regression model using age, gender, % predicted FEV1, FEV1/ FVC, % predicted DLCO as independent variables were used to predict changes. Results: Patients who completed the pulmonary program showed significant changes in favour of post scores on all four scales at p<0.001. The program significantly reduced anxiety and depression, and increased positive psychological outlook in severe pulmonary disease. Perceived breathlessness on the Borg Scale was significantly reduced ( p<0.0001). The multiple regression model was not statistically significant for prediction of any of the changes. Conclusions: Patients with severe pulmonary disease can significantly improve their psychological outlook and decrease anxiety and depression when they complete an inpatient pulmonary rehabilitation program. Psychological gains and perception of breathlessness improve with rehabilitation, even though FEV1 and other pulmonary function tests may not predict these changes. A second implication is that rehabilitation improves psychological outlook with both severely ill patients and a group with mixed pulmonary and cardiac disease.