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.

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.