The purpose of the clinical study is to compare the effect of hypnosis intervention on the emotional dimension of the dyspnea during a pulmonary rehabilitation program to the pulmonary rehabilitation program alone. This study will determine if the hypnosis intervention will lead to better maintenance of benefits obtained than the original described method.
While physical activity level is the best predictor of life expectancy for patients with chronic obstructive pulmonary disease (COPD), the majority of patients have physical activity levels well below guidelines. One of the main barriers to regular activity is anxiety related to dyspnea. Defined as a subjective experience of discomfort during breathing, dyspnea is described as a multidimensional phenomenon integrating both the impact dimension (daily disability), the sensory dimension (intensity of dyspnea) and the emotional dimension (unpleasant and anxiety-aspects). The most effective treatment to reduce dyspnea is pulmonary rehabilitation. An overall improvement in dyspnea, and more specifically in its emotional dimension, has been achieved by reducing dyspnea anxiety. By reducing one of the major barriers to regular physical activity, the level of post-rehabilitation physical activity should also be improved. However, paradoxically, many studies have reported that there has been no change in the level of physical activity of patients in post-rehabilitation. A possible hypothesis to explain this decoupling between the improvement of the emotional dimension of dyspnea and the absence of behavioral modification, lies in the disappearance of the effects once at home. Indeed, during a pulmonary rehabilitation stay, patients practice under health professionals' supervision and advices with regular feedback on their abilities. When patients return home left on their own again, dyspnea anxiety is likely to reappear and motivation may not be enough. Several techniques have been proposed to complement traditional interventions in order to strengthen rehabilitation effects. Unfortunately, these are not effective. The use of hypnosis as a complement to rehabilitation programs is a promising perspective to maintain the benefits on the emotional dimension of dyspnea after a rehabilitation program. Its benefits have already been demonstrated in the reduction of acute and chronic pains, in a long-term effectiveness using self-hypnosis techniques. These ensure the continuity of remote management of the intervention. Given the analogy between pain and dyspnea, hypnosis could therefore constitute a therapeutic solution as a complement to rehabilitation to durably reduce dyspnea anxiety in patients with COPD, and promote a better behavior at middle and long term. The investigators hypothesize that hypnosis used in addition to a 4-week pulmonary rehabilitation program will maintain the benefits on the emotional dimension of dyspnea at 6 months in the experimental group compared to a control group. The main objective is to evaluate the impact of a hypnosis intervention during a pulmonary rehabilitation program on the emotional dimension of dyspnea 6 months after patients return home (T2).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
106
Individual hypnosis sessions will be for 1 hour. Each hypnosis session will be standardized and evaluated using a script and an observation grid ( Visual Analogic Scale comfort, patient's hypnotic state...) written in collaboration with experts from Institut Milton Hyland Erickson Toulouse France (IMHETO).
Clinique du Souffle la Vallonie
Lodève, France
Clinique du Souffle la Solane
Osséja, France
Differential of the emotional dimension of dyspnea 6 months after pulmonary rehabilitation (PR)
Assessing differential of the emotional dimension of dyspnea score on the Multidimensional Dyspnea Profile scale (MDP questionnaire Meek et al 2012) 6 months after pulmonary rehabilitation (PR). MDP is a 11 items questionnaire. Each item is graded 0-10. 5 items are devoted to the emotional dimension of dyspnea. High scores indicate high prevalence of symptoms. As proposed by Morélot-Panzini et al in 2016, for filling it up, patient will be asked to focus on his worst dyspnea experience that happened oin the last two weeks.
Time frame: Change from baseline (T0) to 6 month follow-up (T2)
Differential of the emotional dimension of dyspnea from baseline to PR end-stay and from PR end-stay to 6 months after PR
Assessing differential of the emotional dimension of dyspnea score on the Multidimensional Dyspnea Profile scale (MDP questionnaire Meek et al 2012) from baseline to PR end-stay and from PR end-stay to 6 months after PR . MDP is a 11 items questionnaire. Each item is graded 0-10. 5 items are devoted to the emotional dimension of dyspnea. High scores indicate high prevalence of symptoms. As proposed by Morélot-Panzini et al in 2016, for filling it up, patient will be asked to focus on his worst dyspnea experience that happened oin the last two weeks.
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) and from T1 to 6 month follow-up (T2)
Differential of the impact dimension of dyspnea
Assessing differential of the impact dimension of dyspnea score on the modified Medical Research Council scale ( mMRC questionnaire) and on the London Chest of Activity Daily Living (LCADL) at the PR end-stay and 6 months after PR. mMRC is a 1 item questionnaire graded 0-4. High score indicates high prevalence of symptoms. LCADL is a15-item, self-administered questionnaire which allows an evaluation of dyspnea in patients with COPD during daily activities divided into four components: self-care, domestic, physical, and leisure. Patients could score from 0: "I would not do anyway" to 5: "I need someone else to do this". LCADL score is calculated by aggregating the points assigned to each question, with a higher score representing maximal disability.
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Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Differential of the sensory dimension of dyspnea
Assessing differential of the sensory dimension of dyspnea score on the Multidimensional Dyspnea Profile scale (MDP questionnaire Meek et al 2012) at the PR end-stay and 6 months after PR. MDP is a 11 items questionnaire. Each item is graded 0-10. 6 items are devoted to the sensory dimension of dyspnea. High scores indicate high prevalence of symptoms. As proposed by Morélot-Panzini et al in 2016, for filling it up, patient will be asked to focus on his worst dyspnea experience that happened oin the last two weeks.
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Differential of the post-traumatic stress disorder
Assessing differential of the post-traumatic stress disorder score (PCLS questionnaire) at the PR end-stay and 6 months after PR. PCLS is a 17 items questionnaire. Each item is graded 1-5. A score higher than 44 indicates patient has a post-traumatic disorder as defined by in Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) (Weathers et al, 1993).
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Differential of the quality of life
Assessing differential of the quality of life score (COPD Assessment Test-CAT questionnaire) at the PR end-stay and 6 months after PR. CAT is a COPD specific questionnaire including 8 items. Each item is graded 0-5. Global score is comprised between 0 and 40. Higher global score is higher COPD impact on patient's quality of life is.
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Differential of the anxiety and depression
Assessing differential of the anxiety and depression score (Hospital Anxiety and Depression Scale -HADS questionnaire) at the PR end-stay and 6 months after PR. HADS is a 14 items questionnaire (7 items for anxiety and 7 items for depression). Each item is graded 0-3. A score higher than 7 indicates anxiety and/or depression
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Differential of the physical activity and sedentarity levels
Assessing differential of the physical activity and sedentarity levels (Simple Physical Activity Questionnaire (SIMPAQ) at the PR end-stay and 6 months after PR. SIMPAQ is a 5 items questionnaire assessing in the last two weeks physical activity levels, sedentary times and time in bed.
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Questionnaire for assessing psychotropic drug quantity and dosage
A short questionnaire will be used for assessing differential of psychotropic drug quantity and dosage at the PR end-stay and 6 months after PR.
Time frame: Changes from baseline (T0) to at the end of the 4-weeks PR (T1) , from T0 to 6 month follow-up (T2) and from T1 to 6 month follow-up (T2)
Number of exacerbations and hospitalizations
Assessing differential of number of exacerbations and hospitalizations 6 months after PR. Number of exacerbations and hospitalizations happened during the 6 last months will be indicated at T0 (baseline) and at T2 (6 month follow-up)
Time frame: Changes from baseline (T0) to 6 month follow-up (T2)
Hypnosis frequency
Assessing hypnosis frequency 6 months after PR.
Time frame: Changes from baseline (T0) to 6 month follow-up (T2)
Number of participants with previous hypnosis experiences
A questionnaire will be used for assessing patient's previous hypnosis experiences (previous to PR). (counting)
Time frame: Months or/and years before PR baseline (T0)
Self-Hypnosis frequency
Assessing self-hypnosis frequency 6 months after PR.
Time frame: Changes from baseline (T0) to 6 month follow-up (T2)
Number of participants with previous self-hypnosis experiences
A questionnaire will be used for assessing patient's previous self-hypnosis experiences (previous to PR). (counting)
Time frame: Months or/and years before PR baseline (T0)
Relaxation methods frequency
Assessing relaxation methods frequency 6 months after PR.
Time frame: Changes from baseline (T0) to 6 month follow-up (T2)
Number of participants with previous relaxation methods experiences
A questionnaire will be used for assessing patient's previous relaxation methods experiences (previous to PR). (counting)
Time frame: Months or/and years before PR baseline (T0)