The impact of social support in pulmonary rehabilitation of patients with chronic obstructive pulmonary disease

The prospective association of social relationships and activities reported during a round of interviews and medical examinations in 1967-1969 with mortality over the succeeding nine to 12 years was examined for a cohort of 2754 adult (aged 35-69 years as of 1967-1969) men and women in the Tecumseh Community Health Study. After adjustments for age and a variety of risk factors for mortality, men reporting a higher levels of social relationships and activities in 1967-1969 were significantly less likely to die during the follow-up period. Trends for women were similar, but generally nonsignificant once age and other risk factors were controlled. These results were invariant across age, occupational, and health status groups. No association was observed between mortality and satisfaction with social relationships or activities. How and why social relationships and activities predict mortality are discussed and identified as important foci for future research.

A community sample made in the fall of 1972 in Durham County, North Carolina, and that consisted of 331 persons 65 years of age and older was assessed for adequacy of social support along three parameters: roles and available attachments, perceived social support, and frequency of social interaction. This approach to the assessment of social support complements previous approaches to the measurement of social support which have not compared with the various components of the construct. Mortality status, the outcome variable, was determined 30 months after the initial assessment. The crude relative risks of mortality were 1.96 for impaired roles and available attachments, 3.86 for impaired perceived social support, and 2.72 for impaired frequency of social interaction. Ten potential confounding variables-age, sex, race, economic status, physical health status, self-care capacity, depressive symptoms, cognitive functioning, stressful life events, and cigarette smoking-were controlled using binary linear regression analysis. The estimates of relative mortality risk were 2.04, 3.40, and 1.88, respectively, for impaired roles and available attachments, impaired perceived social support, and impaired frequency of social interaction when the control variables were included in a regression model. Therefore, these three parameters of social support significantly predicted 30-month mortality in both crude and controlled analyses in a community sample of older adults.

To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Randomized clinical trial. University medical center. 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen. Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training. Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years. Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS [P < 0.001]; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of -1.4 compared with -0.2 [P < 0.01]), shortness of breath (score of -7.0 compared with +0.6 [P < 0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up. Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.