The effects of a symptom management program on symptom experience and physical function in adults with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease (COPD) encounter the most unpleasant symptoms including fatigue, dyspnea, sleep disturbances, anxiety, and depression related to physical function that are interrelated and influence one another. This study was a randomized controlled trial (RCT) with a repeated measures design aimed to determine the effects of a symptom management program on symptom experience and physical function in adults with COPD. The symptom management program was developed based on the symptom management theory by Dodd et al. (2001). The study was conducted in a district hospital in a northeastern province of Thailand. One hundred and two COPD patients from the COPD clinic who met the inclusion criteria were recruited. The sample was randomly assigned to the experimental group (n=51) and the control group (n=51). The experimental group received eight weeks of the symptom management program and usual care, while the control care group received only usual care. The instruments used were the demographic and clinical data questionnaire, the modified Medical Research Council (mMRC), the COPD Assessment Test (CAT), the Multidimensional Assessment of Fatigue (MAF), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Assessment Scale (HADS) and the 6-Minute Walk Test (6-MWT). Data analysis was performed with descriptive statistics, chi-square testing, independent t-test, and repeated measures multivariate analysis of variance (MANOVA).The results indicated that the symptom management program effectively influenced symptom experience and physical function in the experimental group when measured over time at Weeks 4 and 8 (F = 5.257, p < 0.001), which was a significant improvement in the mean scores for the 6MWD, CAT, mMRC, and MAF (p < 0.001, p < 0.05). The experimental group had significant improvements in the mean scores for the mMRC, and the MAF than before starting the program and better than the control group when measured over time at Weeks 4 and 8 (p < 0.001, p < 0.05). The experimental group had significantly increased the mean score for the 6MWD and had lower mean scores for the CAT than the control group at Week 8 (p < 0.05) with improvement in the mean scores for the 6MWD and CAT at Weeks 4 and 8 (p < 0.001, p < 0.05). However, there were no significant differences in the mean PSQI scores between the experimental and control groups (p > 0.05), but the experimental group had a significantly lower mean PSQI score at Week 4 (p < 0.05). There was a significant decrease in the mean HADS-Anxiety score between the experimental and control groups at Week 8 (p < 0.05), and the mean HADS-Anxiety score had decreased significantly at Week 8 (p < 0.05). There was no statistically significant difference in the mean HADS-Depression score between the two groups during the study (p > 0.05). Integrating this symptom management program can potentially improve the ability of patients with COPD to manage and regulate symptoms successfully. Additionally, the program can facilitate the development of the ability to maintain physical function, thus reducing patients' dependence on their families and society.