Full text is available at the source.
Health technology assessment (Winchester, England)··
A personalized psychological treatment for managing anxiety and depression in people with chronic lung disease
Updated
Abstract
Results from 423 randomised participants indicated that the tailored cognitive-behavioural approach intervention was neither clinically effective nor cost-effective.
- Mean differences in anxiety and depression scores at 6 months did not demonstrate clinically significant effects.
- No differences were observed in secondary outcomes related to health-related quality of life, smoking status, or healthcare use.
- The intervention resulted in a higher cost to the NHS without corresponding improvements in quality of life.
- Participants reported positive effects on their quality of life, despite the intervention's lack of clinical effectiveness.
- More adverse events were reported among intervention participants, but none were related to the trial.
Simplified
BACKGROUND: People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease.
AIM: Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation.
DESIGN: We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity.
SETTING: Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone.
PARTICIPANTS: Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate.
INTERVENTION: The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral.
MAIN OUTCOME MEASURES: Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use.
RESULTS: We analysed results from 423 randomised participants (intervention,= 242; control,= 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. n n
CONCLUSIONS: The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients.
TRIAL REGISTRATION: This trial is registered as ISRCTN59537391.
FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information. Health Technology Assessment
Related papers
Aug '24
Sleep restriction therapy by nurses to improve insomnia in primary care: the HABIT trial
cited by 5 papers
randomized controlled trial
Nov '23
Comparison of guided self-help and individual trauma-focused therapy for post-traumatic stress disorder
cited by 4 papers
randomized controlled trial
Oct '24
Comparing two speech treatments for speech problems in people with Parkinson's disease
cited by 3 papers
randomized controlled trial
Sep '24
Chair-based yoga for older adults with multiple health conditions: a controlled trial with cost and process studies
cited by 4 papers
randomized controlled trial
May '20
Longer stroke rehabilitation support for stroke survivors: the EXTRAS clinical trial
cited by 15 papers
randomized controlled trial
Apr '19
Group memory training program for people with traumatic brain injuries: the ReMemBrIn trial
cited by 9 papers
randomized controlled trial