The Impact of Loneliness on Outcomes of Pulmonary Rehabilitation in Patients with COPD

Abstract

Psychological factors such as negative affect have been demonstrated to impact course and treatment of chronic obstructive pulmonary disease (COPD). However, little is known about the respective impact of social factors. In several other chronic diseases, loneliness has been shown to predict morbidity, but little is known about its impact on COPD. Therefore, this study examined the associations between loneliness and outcome measures of a pulmonary rehabilitation program (PR). Before and after a 3-week inpatient PR program, patients with COPD (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Loneliness was assessed with the Loneliness Scale. The Medical Outcomes Study 36-item short form, 9-item Patient Health Questionnaire, and 7-item General Anxiety Disorder questionnaire were administered as measures of health-related quality of life (HQoL), depression, and anxiety, respectively. Multiple regression analyses showed that at the start of PR, more loneliness was associated with worse levels of functional exercise capacity, HQoL, depression, and anxiety, but with greater improvements in functional exercise capacity and HQoL over the course of PR, even after controlling for age, sex, lung function, and smoking status. Patients with stronger decreases in loneliness from start to end of PR showed stronger improvements in functional exercise capacity and HQoL over the course of PR. The present study shows that subjective loneliness is associated with relevant treatment outcomes in patients with COPD undergoing pulmonary rehabilitation. Therefore, loneliness should be addressed in patients with COPD as it could play a significant role in their disease progression.

Keywords:

• COPD
• pulmonary rehabilitation
• 6-min walk test
• quality of life
• depression
• anxiety

Author contributions

Conception and design (TR, MS, DJ, KS, AvL); data acquisition (MS, DJ, KS); data analysis (TR, AvL); interpretation of data (TR, MS, DJ, TT, WJ, KS, AvL); drafting the manuscript (TR, MS, DJ, TT, WJ, KS, AvL); manuscript revision (TR, MS, DJ, TT, WJ, KS, AvL).

Guarantor statement

TR and AvL had full access to all of the data in the study and take full responsibility for the integrity of the data and accuracy of the data analysis.

Other contributions

The authors wish to thank Sibylle Petersen, Eva Elisabeth Münch, and Berta Obermaier for their assistance during the data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by a research grant from the Research Fund KU Leuven, Belgium (STRT/13/002), by an infrastructure grant from the Herculesstichting, Belgium (AKUL/13/07), and by the “Asthenes” long-term structural funding Methusalem grant (METH/15/011) by the Flemish Government, Belgium. The main RIMTCORE trial (DRKS00004609) was funded by the Deutsche Rentenversicherung. The funders had no role in the design of the study, the collection and analysis of data, or the preparation of the manuscript.