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Effect of dyspnoea-oriented hypnosis as an adjunct to pulmonary rehabilitation on the affective dimension of dyspnoea and physical activity level: a randomised controlled trial.
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Fernandes Nathalie, Alexandre François, Molinier Virginie, Castanyer Adriana, Moine Espérance, Héraud Nelly
Аннотация
BACKGROUND: Pulmonary rehabilitation has limited long-term effects on physical activity levels in patients with COPD. Dyspnoea-related anxiety, part of the affective dimension of dyspnoea, is a major barrier to physical activity. This study assessed whether hypnosis as an adjunct to standard pulmonary rehabilitation could improve the affective dimension of dyspnoea, as well as physical activity levels, 6 months after rehabilitation.
METHODS: In a randomised, open-label trial (ClinicalTrials.gov: NCT04010825), 106 COPD patients were enrolled to receive either conventional 4-week inpatient pulmonary rehabilitation (CONT) or pulmonary rehabilitation plus five 1-h hypnosis sessions (HYPNO) primarily targeting emotional dyspnoea management. The primary outcome was the evolution of the affective dimension of dyspnoea at 6 months, assessed by the Multidimensional Dyspnoea Profile questionnaire. Secondary outcomes included changes in physical activity levels via the Simple Physical Activity Questionnaire.
RESULTS: Affective dyspnoea scores decreased after pulmonary rehabilitation in both groups (p<0.01). At 6 months, improvement persisted only in the HYPNO group (p<0.001 versus baseline), whereas the CONT group returned to baseline (p=0.98). Physical activity levels increased only in the HYPNO group (p<0.05 versus baseline) and were higher than in the CONT group at follow-up (p<0.001). Changes in physical activity levels correlated with changes in affective dyspnoea (r= -0.26, p<0.05).
CONCLUSIONS: The results suggest that a brief intervention of five hypnosis sessions, as an adjunct to pulmonary rehabilitation, maintained the benefits of pulmonary rehabilitation on the affective dimension of dyspnoea 6 months after pulmonary rehabilitation. The improvement in the affective dimension of dyspnoea was associated with an increase in physical activity levels, a key goal of pulmonary rehabilitation that is poorly achieved in usual pulmonary rehabilitation programmes.
METHODS: In a randomised, open-label trial (ClinicalTrials.gov: NCT04010825), 106 COPD patients were enrolled to receive either conventional 4-week inpatient pulmonary rehabilitation (CONT) or pulmonary rehabilitation plus five 1-h hypnosis sessions (HYPNO) primarily targeting emotional dyspnoea management. The primary outcome was the evolution of the affective dimension of dyspnoea at 6 months, assessed by the Multidimensional Dyspnoea Profile questionnaire. Secondary outcomes included changes in physical activity levels via the Simple Physical Activity Questionnaire.
RESULTS: Affective dyspnoea scores decreased after pulmonary rehabilitation in both groups (p<0.01). At 6 months, improvement persisted only in the HYPNO group (p<0.001 versus baseline), whereas the CONT group returned to baseline (p=0.98). Physical activity levels increased only in the HYPNO group (p<0.05 versus baseline) and were higher than in the CONT group at follow-up (p<0.001). Changes in physical activity levels correlated with changes in affective dyspnoea (r= -0.26, p<0.05).
CONCLUSIONS: The results suggest that a brief intervention of five hypnosis sessions, as an adjunct to pulmonary rehabilitation, maintained the benefits of pulmonary rehabilitation on the affective dimension of dyspnoea 6 months after pulmonary rehabilitation. The improvement in the affective dimension of dyspnoea was associated with an increase in physical activity levels, a key goal of pulmonary rehabilitation that is poorly achieved in usual pulmonary rehabilitation programmes.