title: Exploring the Benefits to Caregivers of a Family-Oriented Pulmonary Rehabilitation Program.
abstract: BACKGROUND
  COPD is a highly incapacitating disease, particularly among older people, implying significant burden for family caregivers. Involving caregivers in comprehensive pulmonary rehabilitation programs might benefit their functional coping to care demands; however, there is no objective evidence to sustain such assumption. This study is a secondary analysis aiming to analyze the effects of a family-based pulmonary rehabilitation program on close family caregivers of older subjects with COPD.
  
  
  METHODS
  This is a mixed-method study. Family caregivers were randomly assigned to family-based (experimental) or conventional (control) pulmonary rehabilitation. Caregivers from the family-based pulmonary rehabilitation (n = 20; 80.0% female; age 63.1 ± 9.5 y) attended the psychoeducational component together with their relatives. In the conventional pulmonary rehabilitation, caregivers did not participate (n = 19; 68.4% female; age 53.6 ± 11.3 y). Self-rated instruments (Family Crisis Oriented Personal Scales, Depression Anxiety and Stress Scales, and Carers' Assessment of Difficulties Index) and focus group interviews were used to assess the intervention.
  
  
  RESULTS
  Caregivers from the family-based pulmonary rehabilitation had significantly greater improvements in overall family coping (P = .01), reframing (P = .01), seeking spiritual support (P = .01), and mobilizing to acquire help (P = .02). No significant differences were found for emotional state. Significant improvements in overall burden (P = .01), reactions to caregiving (P = .01), physical demands of caring (P = .044), and poor family support (P = .038) were observed, although there were no significant between-group differences. Qualitative data sustained the benefits of involving family caregivers in pulmonary rehabilitation.
  
  
  CONCLUSIONS
  The findings provide valuable evidence to recommend the inclusion of COPD family caregivers in comprehensive pulmonary rehabilitation. Family-oriented pulmonary rehabilitation maximizes caregivers' adaptive coping and potentially prevents negative psychological outcomes; however, further research is needed.
authors.affiliation: School of Health Sciences, University of Aveiro, Aveiro, Portugal, and Center for Health Technology and Services Research (CINTESIS.UA), Portugal. daniela.figueiredo@ua.pt.
authors.forename: Daniela
authors.initials: D
authors.lastname: Figueiredo
authors.affiliation: Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal, and Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Cruz
authors.affiliation: Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Jácome
authors.affiliation: Lab 3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal, and Institute for Research in Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
authors.forename: Alda
authors.initials: A
authors.lastname: Marques
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D005196:Family Therapy / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: COPD; burden; coping; emotional state; family caregiving