Person-centered approach in pulmonary rehabilitation

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Latinka Basara
T Jalucic Gluncic
O Maletic
D Pelicaric
S Popovic Grle
M Samarzija
M Jakopovic

Abstract

Background. Holistic scope in treating persons with chronic respiratory diseases is one of the main features of pulmonary rehabilitation program (PRP) at Zagreb University. Interventions are provided by a team made of physicians and other health care professionals - physiotherapists, respiratory therapists, nurses, psychologists, occupational therapists, social workers, behavioral specialists, among others. The program itself is tailored to attend to each person's specific needs through careful interdisciplinary examination and treatment planning, establishing commom ground to address disease severity, respiratory symptoms, comorbidities, psychological manifestations and specific limitations a person has in everyday activities. The focus of PRP is the whole person rather than just a person's disease.Aim. To show the impact of PRP's person-centered approach on patient's quality of life (QoL), anxiety, depression and stress levels.Method. Questionnaires designed to measure quality of life (single question scale), anxiety, depression and stress (DASS21) were administred to 54 patients at the beginning and at the end of a three-week pulmonary rehabilitation program. Each patient underwent an individualized program of education, respiratory exercises, nutrition consultation, and psychosocial/behavioral support and intervention.Results. Results showed significant improvement in all measured parameters – higher overall QoL (p<0.01), and lowered anxiety (p< 0.01), depression (p<0.01) and stress levels (p< 0.01).Conclusions. Pulmonary rehabilitation with a person-centered approach as one of its main features appears to improve quality of life and reduce levels of anxiety, depression and stress in persons with chronic respiratory diseases.  

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Regular Articles

References

. Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CR, Freeman TR. Patient-Centered Medicine, Transforming the Clinical Method. Abingdon, Oxfordshire: Radcliffe Medical Press, 2003.

. Spruit MA et al. An Official American Thoracic Society/European Respiratory

. Society Statement: Key Concenpts and Advances in Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 2013; 188: e13-e64.

. Nici L, Donner C, Wouters E, Zuwallack R et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine 2006; 173: 1390–1413.

. ZuWallak R. A history of pulmonary rehabilitation: back to the future. Pneumonologia i Alergologia Polska, 2009; 77:298-301.

. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 172:19.

. Yohannes AM, Dodd M, Webb K. Reliability and validity of a single item measure of quality of life scale for adult patients with cystic fibrosis. Health Quality of Life Outcomes, 2011; 9:105. DOI: 10.1186/1477-7525-9-105.

. Lovibond, SH, Lovibond, PF. Manual for the Depression anxiety Stress Scales. (2nd Ed) Sydney: Psychology Foundation, 1995

. Tian P. S. Oei , Sukanlaya Sawang , Yong Wah Goh, Firdaus Mukhtar (2013): Using the Depression Anxiety Stress Scale 21 (DASS-21) across cultures. International Journal of Psychology, DOI:10.1080/00207594.2012.755535

. Clark CL,Cochrane LM. Assessment of work performance in asthma for determination of cardiorespiratory fitness and training capacity. Thorax, 1988; 43:745-749

. Emery CF, Schein RL,Hauck ER, MACIntyre NR. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychology, 1998; 17:232-240.

. Emery CF, Leatherman NE, BurkerEJ, MacIntyre NR. Psychological outcomes of pulmonary rehabilitation program. Chest, 1991; 100:613-617

. Ries A L. Pulmonary Rehabilitation: Summary of an Evidence-Based Guideline. Respiratory Care 2008 ;Vol 53 No 9.

. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003793. DOI: 10.1002/14651858.CD003793.pub2.

. Heisler M,Vijan S,Anderson RM,Ubel PA,Bernstein SJ, Hofer TP. When do patients and their physicians agree on diabetes treatment goals and strategies and what difference does it make?, Journal of General Internal Medicine, 2003; 18:893-902.

. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V,Mullinis J, Shiels K, Turner-Lawlor PJ, Payne N,Newcombe RG, Ionescu AA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial, Lancet, 2000; 355:362-368.

. Steele BG,Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease, Archives of Physical Medicine and Rehabilitation, 2008; 89:404-41

. British Thoracic Society Guideline on Pulmonary Rehabilitation in Adults. Thorax, 2013; 68,2.

. American Thoracic Society/European Respiratory Society Statement on Pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390–1413.

. Harrison SL, Greening NJ, Williams JE, et al. Have we underestimated the efficacy of pulmonary rehabilitation in in improving mood?. Respir Med 2012; 106:838-44.

. Berry MJ, Rejeski WJ, Miller ME, et al. A lifestyle activity intervention in patients with chronic obstructive pulmonary disease. Respir Med 2010; 104:829-39.

. Mezzich JE, Snaedal J, van Weel C, Heath I. Conceptual Explorations on Person-centered Medicine 2010. Int J Integr Care 2010; 10:e002.

. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD 2012;9:12-15.