Lewko Agnieszka, Bidgood Penelope L, Jewell Andy, Garrod Rachel
Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, UK.
Faculty of Science, Engineering and Computing, Kingston University, UK.
Respir Med. 2014 Jan;108(1):95-102. doi: 10.1016/j.rmed.2013.09.003. Epub 2013 Sep 14.
Subjective fatigue has been recognised as an important, multi-component symptom in COPD. Pulmonary Rehabilitation (PR) improves fatigue component of the Chronic Respiratory Questionnaire, a quality of life (QoL) measure. However, it is not clear if all fatigue dimensions are affected equally. This study aims to evaluate changes in subjective multidimensional fatigue among people with COPD who participated in PR.
Thirty seven stable COPD patients were recruited; 23 patients (15 male) mean age 68.5 (range 49-86) yrs, mean (SD) %predicted FEV1 45.3 (19.8); completed 7 weeks of PR. Assessments (pre and post PR) consisted of the Multidimensional Fatigue Inventory (MFI-20), QoL (SGRQ), Anxiety and Depression (HADS), the London Chest Activity of Daily Living Scale (LCADL), muscle strength, incremental (ISWT) and endurance (ESWT) shuttle walk tests. The differences between pre and post PR fatigue were tested using Wilcoxon's test and relationships with other outcomes were examined using Spearman's correlation.
There were statistically significant improvements in Reduced Activity (RA) (p = 0.01), General (GF) (p < 0.01) and Physical Fatigue (PF) (p = 0.03) components of MFI-20 after PR, but there were no differences in Motivation or Mental Fatigue (p > 0.05). There were significant improvements in ISWT (p < 0.05), ESWT (p < 0.01) and muscle strength (p = 0.03). Statistically significant correlations (p < 0.05) were found between changes in GF and in both ISWT (r = -0.43) and SGRQ impact (r = 0.46); and between RA and ESWT changes (r = -0.45).
Some dimensions of fatigue in COPD are modifiable by a 7-week PR programme. Change in fatigue dimensions in COPD may be associated with a change in maximal or endurance walking distances or QoL.
主观疲劳已被认为是慢性阻塞性肺疾病（COPD）中一种重要的、多因素症状。肺康复（PR）可改善慢性呼吸问卷中的疲劳分量表，这是一种生活质量（QoL）测量指标。然而，目前尚不清楚所有疲劳维度是否受到同等影响。本研究旨在评估参与PR的COPD患者主观多维疲劳的变化。
招募了37例稳定期COPD患者；23例患者（15例男性），平均年龄68.5岁（范围49 - 86岁），平均（标准差）预计FEV1为45.3（19.8）%；完成了7周的PR。评估（PR前后）包括多维疲劳量表（MFI - 20）、生活质量（SGRQ）、焦虑和抑郁（HADS）、伦敦胸部日常生活活动量表（LCADL）、肌肉力量、递增式（ISWT）和耐力（ESWT）往返步行试验。使用Wilcoxon检验来测试PR前后疲劳的差异，并使用Spearman相关性分析来检验与其他结果的关系。
PR后，MFI - 20的活动减少（RA）分量表（p = 0.01）、总体（GF）分量表（p < 0.01）和身体疲劳（PF）分量表（p = 0.03）有统计学显著改善，但动机或精神疲劳方面无差异（p > 0.05）。ISWT（p < 0.05）、ESWT（p < 0.01）和肌肉力量（p = 0.03）有显著改善。在GF变化与ISWT变化（r = -0.43）和SGRQ影响（r = 0.46）之间；以及RA与ESWT变化之间（r = -0.45）发现了统计学显著相关性（p < 0.05）。
COPD患者的某些疲劳维度可通过为期7周的PR计划得到改善。COPD患者疲劳维度的变化可能与最大或耐力步行距离或生活质量的变化有关。
