# A longitudinal study on the correlation between symptom clusters and disease-specific health status in older adults with chronic obstructive pulmonary disease during pulmonary rehabilitation

## TL;DR

This study tracks how symptom clusters in older COPD patients change during rehabilitation and how they affect health status over time.

## Contribution

The study reveals a dynamic shift in symptom clusters and their impact on health status during pulmonary rehabilitation in older COPD patients.

## Key findings

- Symptom clusters evolve from respiratory-metabolic to psychosocial manifestations during rehabilitation.
- The strongest correlation with health status shifts from psychological to social function inhibition over time.
- The findings support integrating symptom cluster assessments into geriatric care for COPD patients.

## Abstract

The present study aims to use a longitudinal design to clarify the dynamic evolution trajectory of symptom clusters in older adults with chronic obstructive pulmonary disease (COPD) during pulmonary rehabilitation and to analyze the longitudinal association between the evolution of these symptom clusters and patients’ disease-specific health status.

A prospective longitudinal study design was employed. From January 2025 to September 2025, 184 older COPD patients receiving pulmonary rehabilitation were enrolled. Data were collected at baseline (T0), 4 weeks (T1), and 12 weeks (T2) of rehabilitation using a general information questionnaire, the Memorial Symptom Assessment Scale (MSAS), and a COPD rehabilitation-specific symptom supplementary assessment tool. Symptom clusters were extracted using exploratory factor analysis. Spearman correlation analysis was used to examine the association between symptom cluster severity and CAT (COPD Assessment Test) disease-specific health status scores.

The symptom cluster structure underwent significant evolution throughout the rehabilitation process. At T0, five core symptom clusters were extracted, dominated by a respiratory-metabolic cluster (shortness of breath, cough, sputum, fatigue), which accounted for a cumulative variance contribution rate of 61.32%. At T1, the symptom clusters reconfigured, with the emergence of a new cluster characterized by post-exertional malaise (muscle soreness, edema). By T2, the structure consolidated into four symptom clusters, with chronic fatigue and social function inhibition (social anxiety, loss of confidence) becoming the core manifestations. Correlation analysis revealed a dynamic change in the impact of symptom clusters on health status: at T0, the psychological-emotional symptom cluster showed the strongest correlation with CAT scores (r = 0.714, p < 0.001); by T2, the social function inhibition cluster became the primary influencing factor (r = 0.691, p < 0.001), indicating a shift in the dominant association from psychological to psychosocial factors over time.

The findings of this study demonstrate that the evolution of symptom clusters in older COPD patients during pulmonary rehabilitation follows a distinct temporal pattern: progressing from a predominance of respiratory-metabolic symptoms, to the prominence of post-exertional malaise, and finally solidifying with psychosocial symptoms as the core manifestation. The primary impact of symptom clusters on health status also shifts across rehabilitation stages. From a public health perspective, our results provide a rationale for integrating symptom cluster assessments into community-based geriatric care and long-term support systems. This approach is vital for promoting healthy aging, as it enables proactive interventions tailored to the evolving needs of older adults with COPD, thereby optimizing resource allocation and improving the sustainability of care for this large patient population.