Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation

Scand J Caring Sci; 2012; 26; 219–227 Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation Aims: This study aimed to evaluate the short‐ and long‐term effects of 4‐week inpatient rehabilitation on health‐related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio‐demographical factors on unaltered or improved HRQL after discharge. Methods: A total of 111 consecutive cases with mild‐to‐very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6‐month follow‐up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George’s Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio‐demography and co‐morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow‐up were analysed by paired‐sample t‐test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. Results: Health‐related quality of life and depression improved between t1 and t2: a change of ?3.6 for the SGRQ impact score (p= 0.009), ?2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of ?4.0 for the SGRQ symptom score (p = 0.012) and a reduction of ?0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1–7.8, p = 0.039). Conclusion: Short‐term benefits on HRQL and depression after rehabilitation relapsed at 6‐month follow‐up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.