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Effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease: a randomized controlled trial
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Pulmonary Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
Karlstad Hospital.
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2009 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 2, 125-136 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To test the effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease.

Design: Randomized controlled trial.

Setting: Pulmonary outpatient department.

Subjects: Thirty patients randomly assigned to a rehabilitation (3 men, 9 women, mean age 66 ( 2) years) or a control group (10 men, 4 women, mean age 64 ( 2) years).

Interventions: The patients in the rehabilitation group participated in a multidisciplinary rehabilitation programme comprising exercise training twice weekly, for a 12-week period, nutritional and self-care advice, and education about disease and energy conservation strategies.

Main measures: Fatigue, functional limitations due to fatigue, functional performance and satisfaction, six-minute walking distance, hand grip strength and health perception were assessed at baseline and after 12 weeks.

Results: At baseline there were no significant differences between the groups, except for gender. The six-minute walking distance was 312.6 (+/- 79.3) m for the rehabilitation group and 3603 (+/- 84.7) m for the control group. After 12 weeks, the rehabilitation group improved their walking distance by 40.6 (+/- 27.2) m (P<0.05). The rehabilitation group improved in performance (from 4.8 (12.0) to 6.0 (+/- 1.5) scores, P<0.01) and satisfaction (from 4.6 (+/- 2.2) to 6.0 (+/- 2.1) scores, P<0.001) with regard to own selected daily activities. No statistically significant differences were seen between the changes within the rehabilitation group and changes within the control group at the 12-week follow-up.

Conclusions: Although the pulmonary rehabilitation programme had an immediate effect, it was not sustained.

Place, publisher, year, edition, pages
2009. Vol. 23, no 2, 125-136 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16975DOI: 10.1177/0269215508096174OAI: oai:DiVA.org:liu-16975DiVA: diva2:200871
Available from: 2009-03-01 Created: 2009-02-27 Last updated: 2017-12-13
In thesis
1. Fatigue, functional status, health and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Fatigue, functional status, health and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe fatigue, functional limitations due to fatigue and health in patients with chronic obstructive pulmonary disease (COPD), as well as to compare patients with individuals from the general population and to test if pulmonary rehabilitation can reduce fatigue and functional limitations, and thus improve health. A further aim was to test the Fatigue Impact Scale (FIS) among patients with COPD.

Two studies (I, II) had a descriptive comparative design with data from 36 and 151 patients with COPD respectively, and 37 and 95 individuals respectively, randomly selected from the general population. One study (III) was a randomised pre-test post-test study with 12 patients with COPD randomised to 12 weeks’ pulmonary rehabilitation and 14 patients in a control group. In a further study (IV), the FIS was tested for validity and reliability among 296 patients with COPD who reported fatigue.

Assessments: Structured questions frequency, duration and severity of fatigue, functional limitations due to fatigue with FIS, six minutes’ walking distance, hand grip strength, functional performance and satisfaction with Canadian Occupational Performance Measure and health with St George’s Hospital Respiratory Questionnaire and Short Form-36.

Almost half of the patients with COPD had a problem with fatigue every day and experienced fatigue as a severe symptom. More than 44% reported that fatigue was one of the worst symptoms. The experience of fatigue was related to the patients’ functional performance and health perceptions. Patients with COPD experienced a higher frequency, longer daily duration and greater severity of fatigue than individuals from the general population. After a 12 week pulmonary rehabilitation programme, there were no statistically significant differences between the patients randomised to the rehabilitation group and those in the control group. The patients in the rehabilitation group improved walking distances, performance and satisfaction with regard to their own selected activities compared with baseline.

Confirmatory factor analysis on the three-factor model proposed for FIS showed that the fit of the model was not acceptable. Further validation of the FIS resulted in a removal of 15 items (FIS-25) and support for Pipers´ theoretical framework of subjective manifestations of fatigue including physical, emotional and cognitive dimensions and a general behavioural factor. The internal consistency, sensitivity and stability correlations of FIS-25 were satisfactory.

In conclusion, fatigue is a major concern among patients with COPD, impacting on functioning and health. Interventions with 12 weeks’ pulmonary rehabilitation might not be effective enough to reduce fatigue and the functional limitations due to fatigue. More research is needed to solve the symptom burden of fatigue and its impact on functioning and health in patients with COPD.

Place, publisher, year, edition, pages
Institutionen för medicin och vård, 2007. 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 980
Keyword
chronic obstructive pulmonary disease, fatigue, functional status, health, pulmonary rehabilitation, Fatigue impact scale, confirmatory factor analysis
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-8268 (URN)978-91-85715-95-4 (ISBN)
Public defence
2007-02-16, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2009-05-15

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Theander, KerstiJakobsson, PerUnosson, Mitra

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