title: Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients.
abstract: OBJECTIVE
  Pulmonary rehabilitation (PR) has emerged over the last decade as an essential component of an integrated approach to managing patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). We sought to examine how depression and anxiety symptom changes relate to disease-specific quality of life outcomes following PR.
  
  
  METHODS
  We performed a cohort study of 81 patients with COPD who completed PR at a Veterans Administration Medical Center. Pulmonary rehabilitation consisted of supervised exercise training and education twice weekly for 8 weeks. Beck Depression and Anxiety Inventories (BDI and BAI) assessed symptom burden at baseline and completion of PR. We measured change in disease-specific quality of life using the dyspnea, mastery, emotion and fatigue domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR) from baseline to completion of PR.
  
  
  RESULTS
  Participants were 69.8±9.1 years old and all male. Forced expiratory volume in 1 s (FEV1) was 1.23±0.39 L. The CRQ-SR scores improved significantly: dyspnea (P<.0001), mastery (P=.015) and fatigue (P=.017). The BDI scores improved significantly (13.1±10.5 to 10.8±9.9, P=.003; BAI: 13.1±10.1 to 12.1±11.7). Multivariate regression models controlling for age, FEV1, depression treatment and anxiety treatment showed that improvement in depressive symptoms were associated with improvement in fatigue (P=.003), emotion (P=.003) and mastery (P=.01). Anxiety symptom change was not significantly associated with change in disease-specific quality of life domains.
  
  
  CONCLUSIONS
  Addressing anxiety symptoms in PR patients may be indicated because disease-specific quality of life improvement appears to be associated with mood.
authors.affiliation: Primary Care Service and the Systems Outcomes and Quality in Chronic disease and Rehabilitation Research Enhancement Award Program, Providence Veterans Affairs Medical Center, Providence, RI, USA. paul.pirraglia@va.gov
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Brian
authors.initials: B
authors.lastname: Casserly
authors.forename: Robert
authors.initials: R
authors.lastname: Velasco
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Borgia
authors.forename: Linda
authors.initials: L
authors.lastname: Nici
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005221:Fatigue / Q000523:psychology; D006801:Humans; D008171:Lung Diseases / Q000523:psychology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome