Background Physical activity levels are often reduced in patients with COPD, but are partially amenable to intervention, predominantly by rehabilitation. Depression and anxiety are also commonly observed co-morbidities, which relate to outcomes such as mortality and admission rates.1 A recent meta-analysis of exercise as a treatment for depression suggested that it may improve depressive symptoms, 2 hence it is recommended by NICE guidance for mild depression. We hypothesised that less active COPD patients would also have higher rates of psychological co-morbidity. Methods 59 consecutive COPD admissions or attendees to COPD clinic were recruited between January and March 2010, screened for anxiety and depression, and questioned regarding activity levels using the Modified Baecke Questionnaire (MBQ). Those who were already on treatment for anxiety or depression were excluded from further analysis (n¼4). Home activity monitoring using the Actigraph was conducted in 20 patients and 6MWT distances recorded. Results 38.2% of patients were anxious and 36.4% depressed, according to HADS. Both related strongly to exacerbation and admission rates over the preceding 12 months (p<0.01), and to QOL as measured by CAT (p<0.01). Perceived activity as measured by MBQ was lower in depressed patients (p¼0.02); this remained significant after regression analysis, adjusting for exacerbations and FEV 1 (p¼0.03). However, actual activity from the Actigraph showed no relationship to either anxiety or depression (both p>0.38). Conclusions Depressed patients perceive their symptoms to be more severe, and therefore their activity levels lower, than non-depressed patients. However, this did not translate into a difference in actual activity levels. Whether exercise programmes can impact on psychological co-morbidity in COPD requires further research.
AimsTo conduct an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological treatments for obsessive-compulsive disorder (OCD), and examine the differential efficacy of psychological treatments by treatment type and format.BackgroundPrevious meta-analyses conclude that efficacious psychological treatments for OCD exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment across a range of indexes, yet most previous meta-analyses in OCD are based solely on effect sizes.MethodWe evaluated treatment efficacy across 24 RCTs (n = 1,667) by conducting clinical significance analyses (using standardised Jacobson methodology) and standardised mean difference within-group effect-size analyses. Outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores, evaluated at post-treatment and follow-up (3-6 months post-treatment).ResultPost-treatment, there was a large significant within-group effect size for treated patients (g = 1.28) and a small significant effect size for controls (g = 0.30). At follow-up, large within-group effect sizes were found for both treated patients (g = 1.45) and controls (g = 0.90). Clinical significance analyses indicated that treated patients were significantly more likely than controls to recover following an intervention, but recovery rates were low; post-intervention, only 32% of treated patients and 3% of controls recovered; rising to 38% and 21% respectively at follow-up. Regardless of allocation, only approximately 20% of patients were asymptomatic at follow-up. Across the different analysis methods, individual cognitive therapy (CT) was the most effective intervention, followed by group CT plus exposure and response prevention. Self-help interventions were generally less effective.ConclusionReliance on aggregated within-group effect sizes may lead to overestimation of the efficacy of psychological treatments for OCD. More research is needed to determine the most effective treatment type and format for patients with OCD.
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