Cognitive Distortion and Functional Impairment in Patients Undergoing Cardiac Rehabilitation

Alan J. Christensen, University of Iowa
Dawn L. Edwards
Patricia J. Moran
Rachel Burke
Patricia Lounsbury
Ellen E.I. Gordon

Abstract

This study examined the influence of cognitivedistortion (e.g., catastrophizing, overgeneralization)on functional impairment among coronary heart disease(CHD) patients undergoing outpatient cardiacrehabilitation. Forty-two CHD patients completed a versionofthe Cognitive Errors Questionnaire (CEQ; Lefebvre,1981) shortly after hospital discharge at the initiationof the rehabilitation program. Functional impairmentwas assessed both pre- and postrehabilitation usingscales from the Sickness Impact Profile (SIP; Bergner etal., 1981) and a measure of peak exercise performance.Consistent with prediction, patients'' CEQ scores were significantly associated withresidualized change in two areas of illness-relatedfunctional impairmentafter controlling for diseaseseverity and prerehabilitation levels of functioning.Patients endorsing a high number of cognitive errors onthe CEQ reported greater impairmentin mobility andpoorer social functioning after completion of therehabilitation program relative to patients making a low number of cognitive errors. CEQ scores did notsignificantly predict changes in impairment in homemanagement or recreational activity or in peak exerciseperformance. These findings provide further evidence that cognitive constructs might be useful inunderstanding individual differences in functionalrehabilitation in medical populations and may haveimplications for the design of cardiac rehabilitationprograms.