Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3059 — Randomized Controlled Trial of a Mind-Body Therapy for Dyspnea in Advanced COPD

Munjas BA (Sepulveda COE) , Mularski RM (Kaiser Permanente Northwest, Center for Health Research), Lorenz KA (Sepulveda COE), Sun S (Sepulveda COE), Robertson SJ (Greater Los Angeles Medical Center), Schmelzer W (Greater Los Angeles Medical Center), Kim A (Greater Los Angeles Medical Center), Shekelle PG (Sepulveda COE)

Objectives:
Chronic obstructive lung disease results in significant dyspnea. Dyspnea involves complex mind-body interactions. Mind body therapies have been shown to benefit patients with other symptoms such as pain and anxiety. We therefore tested the efficacy of a mindfulness-based breathing therapy (MBBT) on improvement in symptoms and functional limitations.

Methods:
Randomized controlled trial of 8 week MBBT in COPD. MBBT was based on the work of Kabat-Zinn and Benson and included weekly meetings where patients practiced variations of mindfulness mediation and the relaxation response. Control patients also met weekly in a support group in order to control for contact time with a provider. The main outcome measure was the post-6 minute walk test Borg dyspnea assessment; other outcome measures included the St. George’s Respiratory Questionnaire, veteran SF-36 physical (PCS) and mental (MCS) summary score, 6 minute walk distance, a measure of mindfulness (FFMS), and a general symptom scale (MSAS). ANCOVA compared differences in outcomes between groups; paired t-test evaluated changes within groups. Analysis was done both on an intention-to-treat basis and for the subset of subjects who completed allocated control or intervention.

Results:
86 veterans (average SF-36 physical scale=34) were randomized; 29 control and 21 intervention patients completed the trial. We found no differences (p > 0.10 for all comparisons) between groups in any outcome measure by either intention-to-treat analysis or within the subset that attended at least 6 sessions (n=37). In the MBBT group, the PCS score worsened within individuals by an average 3.5 points (p=0.03). In the control group, symptom scores improved modestly, MSAS decreased by < 1 point (p=0.05) and SGRQ symptom subscale decreased 7.5 points (p=0.04).

Implications:
This trial found no improvements in symptoms or function in veterans with COPD attending a MBBT group as compared to a support group. Retention of veterans in the trial was much lower than in previous mind-body trials, suggesting that this time-intensive intervention may not be well received among ill, community-based veterans.

Impacts:
Complementary and alternative medicine (CAM) therapies should undergo careful testing for efficacy in veterans. Uncritical acceptance of CAM therapies risks implementation of ineffective treatments.