title: Coping styles in patients with COPD before and after pulmonary rehabilitation.
abstract: BACKGROUND
  Pulmonary rehabilitation (PR) improves physical and psychological symptoms in COPD patients. Patients' coping with daily symptoms and limitations may have more influence on important patient-centred outcomes than the impaired lung function. To date, it remains unknown whether and to what extent coping styles change following PR, and whether coping styles are associated with the outcomes of a comprehensive PR.
  
  
  METHODS
  Coping styles were assessed in 303 COPD patients before and after a PR programme using the Utrecht Coping List (UCL). Additionally, lung function, St. George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscales and six-minute walking distance (6MWD) were recorded.
  
  
  RESULTS
  The level of active confronting coping style increased (p < 0.05), whereas the levels of avoidance (p < 0.05), passive reaction pattern and reassuring thoughts coping styles decreased following PR (both p < 0.001). More than 50% of the patients changed their level of active confronting, passive reaction pattern or expressing emotions coping style. Coping styles and/or changes in coping styles after PR were related to changes in exercise tolerance, anxiety and depression, but were not related to changes in health status. Following PR, SGRQ total score, HADS-A and HADS-D scores decreased (all p < 0.001), while 6MWD increased (p < 0.05).
  
  
  CONCLUSIONS
  Comprehensive PR results in change in coping styles of COPD patients. Coping styles are related to improvements in exercise tolerance, anxiety and depression, but they are not related with changes in health status after PR. Further studies are needed to evaluate the outcome of interventions actively targeting coping styles.
authors.affiliation: Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), P.O. Box 616, 6200 MD Maastricht, The Netherlands. a.stoilkova@maastrichtuniversity.nl
authors.forename: Ana
authors.initials: A
authors.lastname: Stoilkova
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
authors.forename: Frits M E
authors.initials: FM
authors.lastname: Franssen
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000209:etiology / Q000523:psychology; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome