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Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale.

ABSTRACT: The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depression (HADS-A ? 8 or/and HADS-D ? 8), as well as a propensity score-matched control group of patients with COPD, underwent an 8-week outpatient PR programme (two supervised sessions per week). Within- and between-group changes were calculated in response to PR. Anchor- and distribution-based methods were used to estimate the MCID. HADS-A and HADS-D improved in response to PR in both patients with bronchiectasis and those with COPD (median (25th, 75th centile)/mean (95% confidence interval) change: HADS-A change: bronchiectasis -2 (-5, 0), COPD -2 (-4, 0); p = 0.43 and HADS-D change: bronchiectasis -2 (-2 to -1), COPD -2 (-3 to -2); p = 0.16). Using 26 estimates, the MCID for HADS-A and HADS-D was -2 points. HADS-A and HADS-D are responsive to PR in patients with bronchiectasis and symptoms of mood disorder, with an MCID estimate of -2 points.

SUBMITTER: Wynne SC

PROVIDER: S-EPMC7301664 | biostudies-literature | 2020 Jan-Dec

REPOSITORIES: biostudies-literature

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Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale.

Wynne Stephanie C SC Patel Suhani S Barker Ruth E RE Jones Sarah E SE Walsh Jessica A JA Kon Samantha Sc SS Cairn Julius J Loebinger Michael R MR Wilson Robert R Man William D-C WD Nolan Claire M CM

Chronic respiratory disease 20200101

The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depressi ...[more]

PMID: 32545998

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Project description:BACKGROUND:Idiopathic pulmonary fibrosis (IPF) specific version of St. George's Respiratory Questionnaire (SGRQ-I) and King's Brief Interstitial Lung Disease questionnaire (K-BILD) are validated health-related quality of life (HRQL) instruments, but no or limited data exist on their responsiveness and minimal clinically important difference (MCID). The objectives of this study were to assess responsiveness of SGRQ-I and K-BILD and determine MCID separately for deterioration and improvement in a large, prospective cohort of patients with IPF in a real-world setting. METHODS:Consecutive patients with IPF were recruited. SGRQ-I, K-BILD, SGRQ, Shortness of Breath Questionnaire, pulmonary function tests and 6-min walk test measurements were obtained at baseline and at six and 12?months; at six and 12?months, patients also completed Global Rating of Change Scales. Responsiveness was assessed using correlation coefficients and linear regression. Cox regression was used for mortality analyses. MCID was estimated using receiver operating characteristic curves with separate analyses for improvement and deterioration. RESULTS:A total of 150 IPF patients were included and 124 completed the 12-month follow-up. Based on all HRQL anchors and most physiological anchors, responsiveness analyses supported the evidence pointing towards SGRQ-I and K-BILD as responsive instruments. Multivariate analyses showed an association between SGRQ-I and mortality (HR: 1.18, 95% CI: 1.02 to 1.36, p?=?0.03) and a trend was found for K-BILD (HR: 0.82, 95% CI: 0.64 to 1.05, p?=?0.12). MCID was estimated for all domains of SGRQ-I and K-BILD. MCID for improvement differed from deterioration for both SGRQ-I Total (3.9 and 4.9) and K-BILD Total (4.7 and 2.7). CONCLUSIONS:SGRQ-I and K-BILD were responsive to change concerning both HRQL and most physiological anchors. MCID was determined separately for improvement and deterioration, resulting in different estimates; especially a smaller estimate for deterioration compared to improvement in K-BILD. TRIAL REGISTRATION:Clinicaltrials.gov, no. NCT02818712. Registered 30 June 2016.

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Project description:Background and objectivesField exercise tests (eg, 6-minute walk test [6MWT]) are important measures of functional exercise capacity in people with COPD. Shorter tests such as the 2-minute walk test (2MWT) may offer advantages in some populations but lack information about responsiveness to change. This study examined responsiveness, minimal important difference (MID), test-retest reliability, and construct validity of the 2MWT in people with stable COPD attending outpatient pulmonary rehabilitation (PR).MethodsAt pre-PR assessment, study participants completed a 2MWT twice in addition to usual measures (6MWT and Chronic Respiratory Questionnaire). At post-PR assessment following a standard PR program, measures were repeated and global rating of change scores obtained (patient and therapist). Pre-post program change scores were examined for correlations with change in 2-minute walk distance (2MWD) and used (where r≥0.3) to estimate the MID through anchor-based methods. Distribution-based estimates based on standard error of measurement were examined. Test-retest reliability (intraclass correlation coefficient [ICC] and Bland-Altman agreement) and validity (Pearson correlation with 6-minute walk distance [6MWD]) were reported.ResultsFifty-nine people (28 men) with stable COPD, mean age 68 years (SD 10 years), and percentage predicted forced expiratory volume in 1 second 48% (SD 20%) attended pre-PR assessment. Test-retest ICC for same-session 2MWD was 0.985. A mean difference of 2.4 m (95% confidence interval [CI] 0.7-4.0 m, P=0.006) occurred between the first and second trials. 2MWD and 6MWD were highly correlated (r=0.87, P<0.001). Forty-one participants completed PR and were included in responsiveness and MID analysis. Mean 2MWD improved significantly post-PR (8.8 m, 95% CI 3.6-14 m, P=0.001). The MID in 2MWD, anchored against clinically meaningful change in 6MWD, was 5.5 m (area under curve =0.81, P=0.001). Distribution-based methods estimated an MID of 4 m.ConclusionChange in 2MWD of at least 5.5 m following a PR program corresponded to a clinically meaningful change. A practice test is recommended due to learning effects.

Dataset Information

Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale.

Publications

Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale.

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