Pulmonary Rehabilitation with and without a Cognitive Behavioral Intervention for Breathlessness in People Living with Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial
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Date
2023
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Williams, M.T.
Lewthwaite, H.
Paquet, C.
Cafarella, P.
Frith, P.
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Journal of Clinical Medicine, 2023; 12(23):7286-1-7286-20
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Marie T. Williams, Hayley Lewthwaite, Catherine Paquet, Paul Cafarella, and Peter Frith
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Abstract
(1) Background: Most controlled trials of cognitive behavior therapy (CBT) in people living with chronic obstructive pulmonary disease (COPD) have targeted anxiety and depression. (2) Methods: This pragmatic randomized controlled trial explored whether a comprehensive pulmonary rehabilitation program (CPRP) with CBT for breathlessness or social group control (CPRP + SC) significantly improved health outcomes. (3) Results: People with moderate-to-severe COPD were block randomized (CPRP + CBT n = 52 or CPRP + SC n = 49). Primary outcomes (Hospital Anxiety and Depression scale (HADs), six-minute walk distance (6MWD)) and secondary outcomes (breathlessness, quality of life and habitual physical activity) were assessed before and 1, 6 and 12 months post intervention. Between-group differences were calculated with mixed models for each time point to baseline (intention to treat (ITT)). Participants (n = 101, mean ± SD age 70 ± 8.5 years, 54 (53%) males, FEV1% pred 47.7 ± 16.3) were similar between groups. Post intervention, primary outcomes did not differ significantly between groups at 1 (6MWD mean difference —7.5 [95% CI —34.3 to 19.4], HADs-A —0.3 [—1.4 to 0.9], HADs-D 0.2 [—0.8 to 1.3]), 6 (6MWD —11.5 [—38.1 to 15.1], HADs-A 1.1 [0.0 to 2.2], HADs-D 0.2 [—0.9 to 1.3]), or 12 months (6MWD —3.8 [—27.2 to 19.6], HADS-A —0.4 [—1.5 to 0.6], HADs-D —0.7 [—1.7 to 0.4]). (4) Conclusions: In this cohort, combining CBT with a CPRP did not provide additional health benefits beyond those achieved by a standard CPRP.
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).