Department of Psychiatry.
Department of Anesthesia.
Health Psychol. 2019 Oct;38(10):900-909. doi: 10.1037/hea0000781. Epub 2019 Aug 5.
Depression and poor functional status (FS) frequently co-occur. Though both predict adverse surgical outcomes, research examining preoperative functional performance (FP; self-reported) and functional capacity (FC; performance-based) measures in depressed cancer patients is lacking. Prehabilitation, a preoperative intervention including exercise, nutrition, and stress-reduction, may improve FC; however, whether depressed patients benefit from this intervention remains unknown. The primary objectives were to (a) assess differences in FP and FC and (b) explore the impact of prehabilitation on FC in individuals with depressive symptoms versus those without.
A secondary analysis was conducted on 172 colorectal cancer patients enrolled in three studies comparing prehabilitation with a control group (rehabilitation). Measures were collected at 4 weeks pre- and 8 weeks postoperatively. FP, FC, and psychological symptoms were assessed using the 36-Item Short Form Health Survey, Six-Minute Walk Distance (6MWD), and Hospital Anxiety and Depression Scale (HADS), respectively. Subjects were divided into three groups according to baseline psychological symptoms: no psychological-symptoms (HADS-N), anxiety-symptoms (HADS-A), or depressive-symptoms (HADS-D). Main objectives were tested using analyses of variance, chi-square tests, and multivariate logistic regression.
At baseline, HADS-D reported lower FP, had shorter 6MWD, and a greater proportion walked ≤ 400 m. Prehabilitation was associated with significant improvements in 6MWD in HADS-D group but not in HADS-N or HADS-A groups.
Poorer FS was observed in subjects with depressive symptoms, and these subjects benefited most from prehabilitation intervention. Future research could examine whether severity of depression and co-occurrence of anxiety differentially impact FS and whether prehabilitation can improve psychological symptoms and quality of life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
抑郁和较差的功能状态（FS）经常同时发生。尽管两者都预测手术结局不良，但研究检查术前功能表现（FP；自我报告）和功能能力（FC；基于表现的）在抑郁癌症患者中尚缺乏。术前康复是一种包括运动、营养和减轻压力的术前干预措施，可能会提高 FC；然而，抑郁患者是否受益于这种干预措施尚不清楚。主要目的是（a）评估 FP 和 FC 的差异，（b）探讨术前康复对有抑郁症状与无抑郁症状个体 FC 的影响。
对参加三项比较术前康复与对照组（康复）的研究的 172 例结直肠癌患者进行了二次分析。在术前 4 周和术后 8 周采集了测量值。FP、FC 和心理症状分别使用 36 项简短健康调查、6 分钟步行距离（6MWD）和医院焦虑和抑郁量表（HADS）进行评估。根据基线心理症状将患者分为三组：无心理症状（HADS-N）、焦虑症状（HADS-A）或抑郁症状（HADS-D）。主要目标使用方差分析、卡方检验和多变量逻辑回归进行测试。
基线时，HADS-D 报告的 FP 较低，6MWD 较短，行走≤400m 的比例较高。术前康复与 HADS-D 组的 6MWD 显著改善相关，但与 HADS-N 或 HADS-A 组无关。
在有抑郁症状的受试者中观察到较差的 FS，这些受试者从术前康复干预中获益最大。未来的研究可以研究抑郁的严重程度和焦虑的同时发生是否会对 FS 产生不同的影响，以及术前康复是否可以改善心理症状和生活质量。
