CClinicalTrials.gg
CompletedNCT03470025IMPROVEUpdated Jun 26, 2023

Improving Psychosocial Well-being in COPD Patients in Rehabilitation

An interventional study of Psychological Intervention in COPD, sponsored by IRCCS San Raffaele Roma. Completed at 1 site in Italy. Per ClinicalTrials.gov, last updated 2023-06-26.

Sponsored by IRCCS San Raffaele Roma · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
31
Allocation
Randomized
Sex
All
01

Study summary

Because of a lack of clinical trials, there is currently a paucity of evidence on the most effective strategies to identify and address psychological co-morbidity in COPD, or on targeting these interventions to specific patient groups. The relationship between physiological disease impairment and patient's disease experience is weak. Some patients have highly impaired Quality of life (QoL) despite relatively minor lung function impairment, and others have good QoL despite severe lung function impairment. It is likely that psychological and behavioral factors may be relevant; moreover the coping strategies used by patients and their relationship to individual psychological factors have been incompletely explored. Pulmonary Rehabilitation (PR) is part of integrated COPD patient management and its potential impact on QoL should be underlined: several studies have found that physical exercise has a beneficial effect on depression symptoms [GOLD, 2017].

Before initiating PR a comprehensive and careful assessment should be performed: treatment goals, specific healthcare needs, smoking status, nutritional health, self-management capacity, health educational, psychological health status and social circumstances, medical history and comorbidities, and exercise capabilities and limitations. Moreover, PR has beneficial effects on mood status and daily activities.

Sustaining Pulmonary Rehabilitation benefits and regular exercise over the long term is difficult without any maintenance strategy. The main aim of this study is to assess the Effect of the Psychological Intervention (PI) on Quality of life, psychological status and well-being, and the maintenance of Pulmonary Rehabilitation benefits, in COPD patients.

A PI based on psychoeducation and psychological and emotional support may be a key to improve Quality of life and to bring COPD patients to show a greater awareness of their health status.

Read the detailed description

In this pilot study we will perform two different methodologies of the Psychological Intervention: a telephone-based Psychological Intervention and combined face to face \& telephone-based Psychological Intervention, integrating the COPD rehabilitation.

The study will be carried out in a real life setting. An initial sample of 36 COPD patients satisfying the inclusion criteria and accepting the participation of the study will be enrolled at the PR Unit of the IRCCS "San Raffaele Pisana" Roma-Italy. The study enrollment period will be of maximum six months, the treatment period is of six months, and the interim treatment evaluation is of three months will be performed. Max study duration will be of 12 months.

The participants will be recruited prospectively from consecutively admitted patients to the inpatient PR Unit. Participants will be required to have the diagnosis of COPD according to the ATS' Guideline [Qaseem et al., 2011]. All participants will sign informed consent approved by the Institutional Ethic Committee.

02

Conditions studied

  • COPD

Keywords

  • Rehabilitation
  • Psychological Intervention
  • Quality of life
03

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Diagnosis of COPD
  • Mini-Mental State Examination (MMSE) ≥ 26
  • 6 Minute Walking Test ≥ 90 meters , at admission
  • Obtaining Written Informed Consent

Exclusion criteria

Exclusion Criteria:

  • Comorbidity influencing respiratory ability and functionality
  • Delta 6 Minute Walking Distance \< 60 meters, at time of admission
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
31 participants (actual)

Study arms

  • Experimental
    Psychological Intervention

    A weekly combined face to face \& telephone-based PI (F-TPI); Psychological Intervention and medical therapy

    Other: Psychological Intervention

  • Experimental
    A telephone-based PI (TPI)

    Psychological Intervention - A telephone-based PI (TPI); Psychological Intervention and medical therapy

    Other: Psychological Intervention

  • No intervention
    Optimal medical therapy

    Patients will receive optimal medical therapy

Interventions

  • OtherPsychological Intervention

    1. F-TPI group will be followed for a period of six months with a telephone-based and a face to face psychological intervention, performed by a clinical psychotherapist . 2. TPI group will be followed for a period of six months with a TPI characterized by 10 telephone clinical interviews, performed by a clinical psychotherapist. 3. CTRL group with COPD SoC without PI will follow the standard follow-up program for COPD patients after PR.

    Also known as: Medical therapy

05

What researchers measure

Primary outcomes

  1. Change in Health related Quality of Life evaluated by the St. George's Respiratory Questionnaire

    the St. George's Respiratory Questionnaire score

    Time frame: day 0 to day 182

  2. Change in Quality of Life evaluated by the Short Form Health Survey General and Mental Health

    the Short Form Health Survey General and Mental Health score

    Time frame: day 0 to day 182

  3. Change in the degree of enjoyment and satisfaction in areas of daily functioning, evaluated by the Quality Of Life Enjoyment And Satisfaction Questionnaire

    the Quality Of Life Enjoyment And Satisfaction Questionnaire score

    Time frame: day 0 to day 182

  4. Maintenance of Functional Exercise evaluated by the Six Minute Walking Test

    the Six Minute Walking Test score

    Time frame: day 0 to day 182

  5. Maintenance of Respiratory Capacity evaluated by the Borg scale

    the Borg scale score

    Time frame: day 0 to day 182

  6. Assessment of dyspnea in activities of daily living by the Medical Research Council scale

    the Medical Research Council score

    Time frame: day 0 to day 21 (period of the Pulmonary Rehabilitation )

  7. Assessment of Respiratory Capacity by the Maugeri Foundation Respiratory Failure Questionnaire

    the Maugeri Foundation Respiratory Failure score

    Time frame: day 0 to day 21 (period of the Pulmonary Rehabilitation)

  8. Assessment of disability by the Barthel Index

    Barthel Index score

    Time frame: day 0 to day 21 (period of the Pulmonary Rehabilitation )

Secondary outcomes

  1. Change in psychological status evaluated by the Symptom Check List (SCL-90)

    the SCL-90 scores

    Time frame: day 0 to day 182

  2. Assessment of the severity of depression by the Beck Depression Inventory II

    the Beck Depression Inventory score

    Time frame: day 0 to day 182

  3. Assessment of different types of anxiety, state anxiety and trait anxiety, by State-Trait Anxiety Inventory Form Y.

    the State-Trait Anxiety Inventory scores

    Time frame: day 0 to day 182

  4. Change in the use of the Coping Strategies evaluated by Brief-COPE

    Brief-COPE

    Time frame: day 0 to day 182

06

Study locations

1 site
  • IRCCS San Raffaele Pisana
    Roma, I-00163, Italy
07

References and documents

Publications

  • Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100. doi: 10.1207/s15327558ijbm0401_6. PubMed 16250744 ↗
  • Celli B, Tetzlaff K, Criner G, Polkey MI, Sciurba F, Casaburi R, Tal-Singer R, Kawata A, Merrill D, Rennard S; COPD Biomarker Qualification Consortium. The 6-Minute-Walk Distance Test as a Chronic Obstructive Pulmonary Disease Stratification Tool. Insights from the COPD Biomarker Qualification Consortium. Am J Respir Crit Care Med. 2016 Dec 15;194(12):1483-1493. doi: 10.1164/rccm.201508-1653OC. PubMed 27332504 ↗
  • Chen Q, Wu C, Gao Y, Chen L, Liu Y. A clinical study on the role of psychosomatic therapy in evaluation and treatment of patients with chronic obstructive pulmonary disease complicated with anxiety-depression disorder. Int J Clin Exp Med. 2015 Sep 15;8(9):16613-9. eCollection 2015. PubMed 26629192 ↗
  • Graydon JE, Ross E. Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD. Res Nurs Health. 1995 Dec;18(6):525-33. doi: 10.1002/nur.4770180608. PubMed 7480853 ↗
  • Guell MR, Cejudo P, Ortega F, Puy MC, Rodriguez-Trigo G, Pijoan JI, Martinez-Indart L, Gorostiza A, Bdeir K, Celli B, Galdiz JB. Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up. Am J Respir Crit Care Med. 2017 Mar 1;195(5):622-629. doi: 10.1164/rccm.201603-0602OC. PubMed 27611807 ↗
  • Healy K. A Theory of Human Motivation by Abraham H. Maslow - reflection. Br J Psychiatry. 2016 Apr;208(4):313. doi: 10.1192/bjp.bp.115.179622. No abstract available. PubMed 27036694 ↗
  • Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, McCormack MC, Carlin BW, Sciurba FC, Pitta F, Wanger J, MacIntyre N, Kaminsky DA, Culver BH, Revill SM, Hernandes NA, Andrianopoulos V, Camillo CA, Mitchell KE, Lee AL, Hill CJ, Singh SJ. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1428-46. doi: 10.1183/09031936.00150314. Epub 2014 Oct 30. PubMed 25359355 ↗
  • Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992 Jun;145(6):1321-7. doi: 10.1164/ajrccm/145.6.1321. PubMed 1595997 ↗
  • Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, Stanley MA. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005 Apr;127(4):1205-11. doi: 10.1378/chest.127.4.1205. PubMed 15821196 ↗
  • Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med. 1993 May-Jun;55(3):234-47. doi: 10.1097/00006842-199305000-00002. No abstract available. PubMed 8346332 ↗
  • Martinez FD. Early-Life Origins of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2016 Sep 1;375(9):871-8. doi: 10.1056/NEJMra1603287. No abstract available. PubMed 27579637 ↗
  • Martinu T, Babyak MA, O'Connell CF, Carney RM, Trulock EP, Davis RD, Blumenthal JA, Palmer SM; INSPIRE Investigators. Baseline 6-min walk distance predicts survival in lung transplant candidates. Am J Transplant. 2008 Jul;8(7):1498-505. doi: 10.1111/j.1600-6143.2008.02264.x. PubMed 18510641 ↗
  • Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA; ACCP Workshop Panel on Anxiety and Depression in COPD. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008 Oct;134(4 Suppl):43S-56S. doi: 10.1378/chest.08-0342. PubMed 18842932 ↗
  • Perret JL, Walters EH, Abramson MJ, McDonald CF, Dharmage SC. The independent and combined effects of lifetime smoke exposures and asthma as they relate to COPD. Expert Rev Respir Med. 2014 Aug;8(4):503-14. doi: 10.1586/17476348.2014.905913. Epub 2014 May 16. PubMed 24834459 ↗
  • Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schunemann H, Wedzicha W, MacDonald R, Shekelle P; American College of Physicians; American College of Chest Physicians; American Thoracic Society; European Respiratory Society. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-91. doi: 10.7326/0003-4819-155-3-201108020-00008. PubMed 21810710 ↗
  • Russo P, Prinzi G, Kisialiou A, Cardaci V, Stirpe E, Conti V, Fini M, Bonassi S. WITHDRAWN: Action plans and coping strategies in elderly COPD patients influence the result of pulmonary rehabilitation: an observational study. Eur J Phys Rehabil Med. 2017 Apr 14. doi: 10.23736/S1973-9087.17.04501-4. Online ahead of print. PubMed 28417609 ↗
  • Smoller JW, Pollack MH, Otto MW, Rosenbaum JF, Kradin RL. Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. Am J Respir Crit Care Med. 1996 Jul;154(1):6-17. doi: 10.1164/ajrccm.154.1.8680700. PubMed 8680700 ↗
  • Usmani ZA, Carson KV, Heslop K, Esterman AJ, De Soyza A, Smith BJ. Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Mar 21;3(3):CD010673. doi: 10.1002/14651858.CD010673.pub2. PubMed 28322440 ↗
  • van Manen JG, Bindels PJ, Dekker FW, IJzermans CJ, van der Zee JS, Schade E. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax. 2002 May;57(5):412-6. doi: 10.1136/thorax.57.5.412. PubMed 11978917 ↗
  • Vanfleteren LEGW, Spruit MA, Wouters EFM, Franssen FME. Management of chronic obstructive pulmonary disease beyond the lungs. Lancet Respir Med. 2016 Nov;4(11):911-924. doi: 10.1016/S2213-2600(16)00097-7. Epub 2016 Jun 2. PubMed 27264777 ↗
  • Vogele C, von Leupoldt A. Mental disorders in chronic obstructive pulmonary disease (COPD). Respir Med. 2008 May;102(5):764-73. doi: 10.1016/j.rmed.2007.12.006. Epub 2008 Jan 28. PubMed 18222685 ↗
  • Woodruff PG, Agusti A, Roche N, Singh D, Martinez FJ. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. Lancet. 2015 May 2;385(9979):1789-1798. doi: 10.1016/S0140-6736(15)60693-6. PubMed 25943943 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03470025
Lead sponsor
IRCCS San Raffaele Roma
Responsible party
Sponsor
First posted
Mar 19, 2018
Start date
Jan 10, 2018
Primary completion
May 30, 2019
Completion
Dec 31, 2019
Last update
Jun 26, 2023

Study contacts

Giulia Prinzi, MA
principal investigator · IRCCS San Raffaele Pisana

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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