Health locus of control in pulmonary rehabilitation (PR) of severe COPD patients

Locus of Control (LOC), a construct of social learning theory, has proved to predict and explain specific health-related behaviors, such as adherence to treatment. Aim of the study was to analyze patient9s perception and beliefs about their health condition, and evaluate if LOC may influence PR outcome. We prospectively analyzed 20 consecutive severe COPD patients (13m; age 73.9±7.8 y), included in an intensive, in-hospital, (post-exacerbation) programme. Demographic characteristics, psychological status and LOC were related to PR outcome measurements. A subgroup analysis was done comparing patients reporting greater improvement in dyspnoea (TDI≥2) after PR (Group2) with others (Group1). At baseline, a moderate Functional Independence Scale (FIM) impairment was observed; only 9 patients (45%) were able to accomplish a 6MWT. Mean LOC score results showed high confidence in other people (4.3±1.3) and in doctors (5.2±0.5), with low belief in chance (2.8±1.1). After PR a significant improvement in maximal inspiratory (MIP) and expiratory (MEP) pressures, in Peak Cough Expiratory Flow (PCEF), state anxiety, depression and perceived Quality of Life was also observed. Group1 showed significantly higher FIM and lower PCEF, MIP, MEP and SGRQ at admission compared to Group2. LOC profile and trait anxiety were not different among the two subgroups. At discharge, in Group2 a significant change in MIP, MEP, dyspnoea and state anxiety were observed compared to baseline. Baseline impairment of FIM, PCEF, MIP and MEP predicted lower TDI values after PR in severe COPD patients. TDI was not related to baseline LOC and trait anxiety. In Group2, improvement of dyspnoea was coupled with a reduction in state anxiety.