Blumenthal James A, Emery Charles F, Smith Patrick J, Keefe Francis J, Welty-Wolf Karen, Mabe Stephanie, Martinu Tereza, Johnson Julie J, Babyak Michael A, O'Hayer Virginia F, Diaz Philip T, Durheim Michael, Baucom Donald, Palmer Scott M
From the Departments of Psychiatry and Behavioral Sciences (J.A.B., F.J.K., S.M., J.J.J., M.A.B., P.J.S., V.F.O.H.) and Medicine (S.M.P., K.W.-W., T.M., M.D.), Duke University Medical Center, Durham, North Carolina; Durham Veteran's Administration Hospital (K.W.-W.), Durham, North Carolina; the Department of Psychology (D.B.), University of North Carolina, Chapel Hill, North Carolina; and Departments of Psychology (C.F.E.) and Medicine (P.T.D.), Ohio State University, Columbus, Ohio.
Psychosom Med. 2014 Oct;76(8):581-92. doi: 10.1097/PSY.0000000000000101.
Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life (QoL). Novel interventions are needed to improve outcomes in COPD patients. The present study assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality.
We conducted a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to coping skills training (CST) or to COPD education (COPD-ED). Patients completed a battery of QoL instruments, pulmonary function tests, and functional measures and were followed up for up to 4.4 years to assess medical outcomes.
The CST group exhibited greater improvements in psychological QoL compared with controls (p = .001), including less depression (Cohen d = 0.22 [95% confidence interval, or CI = 0.08-0.36]) and anxiety (d = 0.17 [95% CI = 0.02-0.33]), and better overall mental health (d = 0.17 [95% CI = 0.03-0.32]), emotional role functioning (d = 0.29 [95% CI = 0.10-0.48]), vitality (d = 0.27 [95% CI = 0.11, 0.42]), and social functioning (d = 0.21 [95% CI = 0.03-0.38]). A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED. CST participants also exhibited greater improvements in somatic QoL (p = .042), including greater improvements in pulmonary QoL (d = 0.13 [95% CI = 0.01-0.24]), less fatigue (d = 0.34 [95% CI = 0.18-0.50]), and less shortness of breath (d = 0.11 [95% CI = -0.01 to 0.23]) and greater improvement in distance walked on the Six-Minute Walk test (d = 0.09 [95% CI = 0.01-0.16]). However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events; p = 0.430).
A telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality.
clinicaltrials.gov Identifier: NCT00736268.
慢性阻塞性肺疾病（COPD）与发病率和死亡率增加以及生活质量（QoL）下降相关。需要新的干预措施来改善COPD患者的预后。本研究评估了基于电话的应对技能干预对心理和躯体生活质量以及对COPD相关住院和全因死亡率这一综合医学终点的影响。
我们进行了一项双中心随机临床试验，在基线和治疗16周后进行评估。研究人群包括326名年龄在38至81岁的COPD门诊患者，随机分为应对技能训练（CST）组或COPD教育（COPD - ED）组。患者完成了一系列生活质量量表、肺功能测试和功能测量，并随访长达4.4年以评估医学结局。
与对照组相比，CST组在心理生活质量方面有更大改善（p = 0.001），包括抑郁程度降低（Cohen d = 0.22 [95%置信区间，或CI = 0.08 - 0.36]）和焦虑程度降低（d = 0.17 [95% CI = 0.02 - 0.33]），以及整体心理健康状况更好（d = 0.17 [95% CI = 0.03 - 0.32]）、情感角色功能（d = 0.29 [95% CI = 0.10 - 0.48]）、活力（d = 0.27 [95% CI = 0.11, 0.42]）和社会功能（d = 0.21 [95% CI = 0.03 - 0.38]）。治疗组与基线心理生活质量的显著交互作用表明，基线生活质量较低的CST组与COPD - ED组相比，在心理生活质量方面有更大改善。CST参与者在躯体生活质量方面也有更大改善（p = 0.042）），包括肺部生活质量改善更大（d = 0.13 [95% CI = 0.01 - 0.24]）、疲劳减轻（d = 0.34 [95% CI = 0.18 - 0.50]）、呼吸急促减轻（d = 0.11 [95% CI = -0.01至0.23]）以及六分钟步行试验中步行距离改善更大（d = 0.09 [95% CI = 0.01 - 0.16]）。然而，CST组（34例事件）和COPD - ED组（32例事件；p = 0.430）在COPD相关住院时间或全因死亡率风险方面无显著差异。
远程医疗CST干预在生活质量和功能能力方面产生了具有临床意义的改善，但在COPD相关住院风险和全因死亡率方面没有总体改善。
clinicaltrials.gov标识符：NCT00736268。
