Disease-specific fear and its relationship with outcomes of pulmonary rehabilitation in COPD

Background: It is well established that anxiety is a highly prevalent psychological comorbidity in patients with COPD and as a negative affective trait it has detrimental effects on pulmonary rehabilitation (PR) outcomes. Moreover, disease-specific fears could play an even more important role. However, disease-specific fear is a multifaceted concept and relations of its specific components to PR outcomes are widely unexplored. Therefore, we examined how different disease-specific fears relate to diverse outcomes over the course of PR. Methods: Patients with COPD (N=102) underwent a 3-week inpatient PR program. At the start and end patients performed a 6-min walking test to assess functional exercise capacity. The COPD-Anxiety-Questionnaire and Fear Avoidance Questionnaire COPD were used to measure disease-specific fears. General anxiety, depression, health-related quality of life, dyspnea-related disability, and activity-related dyspnea were measured. Results: Multiple regression analyses demonstrated that at PR start, higher levels of disease specific fears were associated with worse PR outcomes, even after controlling for potential effects of age, sex, lung function, smoking status, and general anxiety. In addition, more favorable changes in disease-specific fears over the course of PR were associated with more favorable changes in these outcomes. Discussion: This study demonstrates that disease-specific fears are negatively related to PR outcomes beyond the effects of general anxiety. Moreover, improvements in these fears could have a positive impact on PR outcomes. Therefore, different disease-specific fears should be assessed and treated in order to improve PR in patients with COPD.