Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients

Coping as a mediator of the relationship between kinesiophobia and illness perception in atrial fibrillation patients: A cross-sectional mediation analysis

AIM(S)

To explore the mediating role of coping styles in the association between illness perception and kinesiophobia in atrial fibrillation patients.

DESIGN

A cross-sectional survey.

METHODS

Between June 2021 and November 2022, data were collected using a self-designed demographic questionnaire, the Brief Illness Perception Questionnaire (BIPQ), Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) and Medical Coping Modes Questionnaire (MCMQ). The sample comprised 474 atrial fibrillation patients recruited from three hospitals in China. To analyse the data, multiple linear regression models with forced entry were employed, and the mediation Mode 4 of the PROCESS macro in SPSS was implemented.

RESULTS

In total, 57.8% of patients exhibited a high level of kinesiophobia. Regression analyses uncovered associations between kinesiophobia and various demographic and disease characteristics, as well as assessments of both illness perception and coping styles. Path analysis results indicated that illness perception reduced kinesiophobia through the mediating effect of confrontation, while avoidance and resignation intensified kinesiophobia. The mediating factor of coping styles explained a significant 53% of the overall effect.

CONCLUSIONS

Coping styles mediate the relationship between illness perception and kinesiophobia, resulting in a shift in coping styles as illness perception decreases and ultimately leading to reduced kinesiophobia.

IMPACT

Coping styles play a mediating role in the relationship between kinesiophobia and illness perception. The results suggest healthcare providers in identifying high-risk individuals and tailoring interventions to effectively break the vicious cycle of kinesiophobia. Therefore, screening and intervening with patients showcasing heightened illness perception aims to promote a transformation in coping styles, subsequently reducing atrial fibrillation kinesiophobia.

REPORTING METHOD

The results of the observations were reported in adherence to the STROBE criteria.

PATIENT OR PUBLIC CONTRIBUTION

No patient and public involvement.

The indirect influence of 'invisible' support on pulmonary function among adults with chronic obstructive pulmonary disease

Individuals living with chronic obstructive pulmonary disease (COPD) often require support from family or friends. We examined whether invisible support - support that is provided but goes unnoticed - is related to pulmonary function, and whether this association is mediated by depressive symptoms and illness perceptions. Sixty-six dyads of individuals with COPD and their informal caregivers reported on receipt and provision of support, respectively. Those with COPD completed measures of depressive symptoms, illness perceptions and pulmonary function. Although invisible support was not directly related to pulmonary function, mediation analyses revealed a combined indirect effect through lower depressive symptoms and less negative illness perceptions. Interventions teaching skillful delivery of support to caregivers may reduce depressive symptoms and threatening illness cognitions, which may contribute to improvements in symptom burden among patients with COPD.

The role of personality traits in inpatient pulmonary rehabilitation response in patients with chronic obstructive pulmonary disease

BACKGROUND

The effectiveness of pulmonary rehabilitation (PR) is a critical issue for chronic obstructive pulmonary disease (COPD) patients. However, PR response is marked by a strong heterogeneity, partially unexplained to date. We hypothesized that personality traits defined by the Five-Factor Model could modulate the effect of inpatient-PR.

OBJECTIVE

The aim was to assess the associations between these five personality traits and PR outcomes.

METHODS

74 persons with COPD admitted for a 5-week inpatient PR program had a personality assessment at the start of the program (T1). Exercise capacity, quality of life, sensory and affective dyspnea dimensions were assessed at T1 and at the end of the program (T2). Their evolution was evaluated using the delta score between T2 and T1. PR response was defined using the minimal clinically important change score for each of them. A composite response was established distinguishing the poor responders' group, made of patients who responded to 0, 1 or 2 parameters and the good responders' group, with patients who responded on 3 or 4 indicators.

RESULTS

Logistic regressions analyses highlighted that those with a high level of openness [OR = 0.36, 95% CI = 0.15-0.74, p < 0.01] were less likely to respond on quality of life, controlling for socio-demographic factors and the severity of the disease.

CONCLUSION

This study shows that the investigation of the personality constitutes an interesting perspective for better understanding the interindividual differences observed between patients in the PR response. Tailoring clinical intervention to the patient's personality could be a promising prospect for optimizing PR effectiveness.

Reduced exercise capacity and self-perceived health status in high-risk patients undergoing lung resection

BACKGROUND

Lung resection represents the main curative treatment modality of non-small cell lung cancer. Patients with high-risk to develop postoperative pulmonary complications have been classified as “high-risk patients.” Characterizing this population could be important to improve their approach and rehabilitation.

AIM

To identify the differences between high and low-risk patients in exercise capacity and self-perceived health status after hospitalization.

METHODS

A longitudinal observational prospective cohort study was carried out. Patients undergoing lung resection were recruited from the “Hospital Virgen de las Nieves” (Granada) and divided into two groups according to the risk profile criteria (age ≥ 70 years, forced expiratory volume in 1 s ≤ 70% predicted, carbon monoxide diffusion capacity ≤ 70% predicted or scheduled pneumonectomy). Outcomes included were exercise capacity (Fatigue Severity Scale, Unsupported Upper-Limb Exercise, handgrip dynamometry, Five Sit-to-stand test, and quadriceps hand-held dynamometry) and patient-reported outcome (Euroqol-5 dimensions 5 Levels Visual Analogue Scale).

RESULTS

In total, 115 participants were included in the study and divided into three groups: high-risk, low-risk and control group. At discharge high-risk patients presented a poorer exercise capacity and a worse self-perceived health status (P < 0.05). One month after discharge patients in the high-risk group maintained these differences compared to the other groups.

CONCLUSION

Our results show a poorer recovery in high-risk patients at discharge and 1 mo after surgery, with lower self-perceived health status and a poorer upper and lower limb exercise capacity. These results are important in the rehabilitation field.

Psychological well-being in people with multiple sclerosis and its association with illness perception and self-esteem

BACKGROUND

Illness perception and self-esteem were found to improve adjustment to disease in many chronic conditions. However, so far, little is known about the role of illness-appraisal and self-appraisal factors in psychological well-being in people with multiple sclerosis (MS). Thus, we aimed to assess the association between illness perception, self-esteem and psychological well-being in people with MS while controlling for sociodemographic variables, clinical variables, and sleep-related problems.

METHODS

The General Health Questionnaire-28, the Brief Illness Perception Questionnaire, the Rosenberg Scale of Self-esteem, the Expanded Disability Status Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Inventory were used. Multiple linear regressions and mediation analyses were utilized to analyse the data.

RESULTS

Positive illness perception (p<0.001) and self-esteem (p<0.05) were significantly associated with psychological well-being in MS. Low income (p<0.05) and sleep-related problems (p<0.001) were significantly associated with lower level of psychological well-being in people with MS. Positive illness perception and self-esteem were able to diminish the association between low income (p>0.05), poor sleep quality (p<0.01), fatigue (p>0.05), and low level of psychological well-being. Self-esteem also mediated the association between illness perception and psychological well-being.

DISCUSSION

People with MS may benefit from psychological support aimed at promoting self-esteem and diminishing negative illness perception.

The breathing brain: The potential of neural oscillations for the understanding of respiratory perception in health and disease

Dyspnea or breathlessness is a symptom occurring in multiple acute and chronic illnesses, however, the understanding of the neural mechanisms underlying its subjective experience is limited. In this topical review, we propose neural oscillatory dynamics and cross-frequency coupling as viable candidates for a neural mechanism underlying respiratory perception, and a technique warranting more attention in respiration research. With the evidence for the potential of neural oscillations in the study of normal and disordered breathing coming from disparate research fields with a limited history of interdisciplinary collaboration, the main objective of the review was to converge the existing research and suggest future directions. The existing findings show that distinct limbic and cortical activations, as measured by hemodynamic responses, underlie dyspnea, however, the time-scale of these activations is not well understood. The recent findings of oscillatory neural activity coupled with the respiratory rhythm could provide the solution to this problem, however, more research with a focus on dyspnea is needed. We also touch on the findings of distinct spectral patterns underlying the changes in breathing due to experimental manipulations, meditation and disease. Subsequently, we suggest general research directions and specific research designs to supplement the current knowledge using neural oscillation techniques. We argue for the benefits of interdisciplinary collaboration and the converging of neuroimaging and behavioral methods to best explain the emergence of the subjective and aversive individual experience of dyspnea.

The Illness Belief Network Questionnaire: Development and Evaluation of a Psychosomatic Assessment Tool

Objective: Patients’ beliefs and emotions toward an illness can influence their coping responses, illness behaviors, adherence to treatment, quality of life, and even the psychoneuroimmune responses. The aim of present study was to develop and validate a novel questionnaire assessing both rational and irrational beliefs of patients regarding their illness.

Method: In a cross sectional methodological study, the items of the Illness Belief Network (IBN) were developed regarding patients and clients’ opinions about and attribution of their disease extracted from 400 clinical interviews and were coded based on Leventhal’s self-regulation model. An expert panel coded the items. A total of 400 patients with different medical conditions completed the questionnaire. Participants additionally rated the Illness Perceptions Questionnaire in its revised form (IPQ-R) to assess convergent validity. Construct validity was examined by conducting exploratory and confirmatory factor analysis. The Cronbach alpha and Intracluster Correlation Coefficient (ICC) were used for examining Internal consistency and test-retest reliability of the IBN.

Results: The IBN questionnaire was finalized with 84 items, and the results of factor analysis revealed 5 factors: psychosocial causes, environmental causes, control, meaning, and consequence/timeline; extracted factors were confirmed by confirmatory factor analysis. Cronbach’s α coefficient for scale was 0.92 and it ranged from 0.79 to 0.89 for the subscales. IBN indicated excellent test-retest reliability results based on ICC 0.842(95%CI: 0.798-0.846). The correlation coefficients of all items exceeded the prespecified acceptable value of 0.40, indicating satisfactory item discriminant validity, and correlation between IBN and IPQ-R subscales were statistically significant (all p values < 0.01), indicating acceptable convergent validity.

Conclusion: The IBN questionnaire is a valid and reliable phenomenological, non-judging, and clinical tool to assess patient’s rational and irrational or faith-based beliefs about the illness. This tool can be used to improve doctor-patient communication by exploring the complex nature of human thinking.

The role of illness perceptions and exercise beliefs in exercise engagement during treatment for cancer

OBJECTIVES

This study examined whether exercise beliefs and illness perceptions were associated with changes in exercise behaviour following a cancer diagnosis.

DESIGN

This study uses a cross-sectional survey of 366 adults with a diagnosis of cancer, who were currently receiving treatment.

MAIN OUTCOME MEASURES

The main outcome measures are symptom severity, pre- and post-morbid exercise levels, exercise beliefs, and illness perceptions.

RESULTS

The majority of participants decreased their level of exercise after diagnosis (Decreasers; 58.1%). Approximately a third increased participation (Increasers; 30.4%) and a small group maintained (Maintainers; 9.2%) their pre-diagnosis exercise levels. After controlling for symptom severity and time since cancer diagnosis, Decreasers reported lower Self-Efficacy for exercise, higher levels of belief in the Negative Impact on Cancer of exercise, lower levels of Personal Control, and less Emotional Representation of their illness, than Increasers. Decreasers also reported lower levels of Self-Efficacy for exercise than Maintainers.

CONCLUSION

The results suggest that identifying unhelpful beliefs about the relationship between exercise and illness during cancer treatment and improving confidence and control of exercise through psycho-educational intervention could be an effective strategy for preventing cancer patients decreasing exercise following their diagnosis.

When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness

Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.

Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study

INTRODUCTION

Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD.

OBJECTIVES

To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects.

MATERIALS AND METHODS

109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance).

RESULTS

BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14).

CONCLUSION

In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.

A Virtual Reality-Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study

BACKGROUND

The uptake of traditional pulmonary rehabilitation classes by patients with chronic obstructive pulmonary disease (COPD) is poor because of personal factors that prevent accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation, and virtual reality (VR) could be a promising technology for patients with COPD to access services remotely.

OBJECTIVE

This study aimed to investigate whether VR improves compliance with pulmonary rehabilitation among patients with COPD, a particularly vulnerable patient group (Medical Research Council [MRC] 4 or 5), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programs.

METHODS

This was an 8-week patient trial using an innovative VR pulmonary rehabilitation program. A purposive sample of 10 patients with COPD graded MRC 4 or 5 and registered at a selected health care center and a hospital in Cumbria, United Kingdom, were included. Qualitative (focus groups and interviews) data were collected, and to further support the qualitative findings, quantitative data (self-report patient surveys) were gathered before and after the 8-week trial. The 5 self-reported surveys included the Patient Activation Measure, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Short Physical Performance Battery, and the Edmonton Frail Scale.

RESULTS

In a thematic analysis of the qualitative data, 11 themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further support the qualitative findings by revealing significant improvements in all physical measures.

CONCLUSIONS

Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to patients with COPD at scale.

How people with chronic obstructive pulmonary disease perceive their illness: a qualitative study between mind and body

Background

Although many studies on people with Chronic Obstructive Pulmonary Disease (COPD) have examined the mutual impact of physical status and emotional experience, there is limited knowledge about the way COPD people first-hand perceive their condition. This study was designed to investigate the illness perceptions of the patients and, secondarily, to explore their beliefs about the mind-body relationship.

Methods

This qualitative study has exploited an ad-hoc semi-structured interview to collect personal perspectives of participants on their illness. Twenty-seven patients (15 males and 12 females), with a mild to severe COPD, were recruited within the Respiratory Rehabilitation Unit of Don Carlo Gnocchi Foundation, in Milan. The thematic analysis of the interviews’ content was facilitated by NVivo (12th version, QSR International®).

Results

The thematic analysis of the corpus resulted in four master themes. Illness experience has been considered the primary one. Indeed, dealing with COPD every day allows these people to portray a specific representation of the mind-body relationship, to gain a certain degree of expertise and to develop a perspective on the future.

Conclusions

Individual perceptions of the illness vary among people with COPD, but some common experiences characterize them. Many patients share a profound belief that their mental state and their physical symptoms are highly interrelated.

Referral of patients with chronic obstructive pulmonary disease to pulmonary rehabilitation: a qualitative study of barriers and enablers for primary healthcare practitioners

BACKGROUND

Pulmonary rehabilitation (PR) is a cost-effective, internationally recommended intervention for patients with chronic obstructive pulmonary disease (COPD). Referral is predominately led by primary healthcare practitioners (PHCPs), but referral and patient uptake is poor.

AIM

To understand barriers and enablers for PHCPs when considering patient referral to PR, to explore the influence of patient characteristics, and to understand how referral rates may be increased.

DESIGN AND SETTING

PHCPs who care for and refer patients with COPD to PR were purposively selected from general practices across Cambridgeshire and Peterborough, and the West Midlands.

METHOD

A qualitative study. Semi-structured interviews were undertaken to theme saturation, exploring PR referral. Images depicting patients with varying COPD severity were used to stimulate memory and associative recall. Interviews were recorded, transcribed verbatim, and analysed using rapid qualitative analysis.

RESULTS

A total of 19 PHCPs were interviewed. Barriers to PR referral included limited awareness of the clinical benefits, little knowledge of local PR providers, consultation time constraints, and presumed low patient motivation. While practice nurses had the greatest knowledge, they still described difficulty in promoting PR. PHCPs frequently described assessing patient suitability based on presumed accessibility, social, and disease-specific characteristics rather than the clinical benefits of PR. Referrals were facilitated by financial incentives for the practice and positive feedback from patients and providers.

CONCLUSION

There were more barriers to PR referral than enablers. Providers must engage better with PHCPs, patients with COPD, and carers, and actively promote PR. Increasing PHCPs' awareness of the benefits of PR, financial incentives, and alternative referral pathways should be considered.

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.

Are Walking Treatment Beliefs and Illness Perceptions Associated With Walking Intention and 6-Min Walk Distance in People With Intermittent Claudication? A Cross-Sectional Study

Intermittent claudication is debilitating leg pain affecting older people with peripheral arterial disease, which is improved by regular walking. This study evaluated associations between psychosocial variables and 6-min walk distance (6MWD) to identify factors that motivate walking. A total of 142 individuals with intermittent claudication (116 males; M_age = 66.9 years [SD = 10.2]) completed cross-sectional assessments of sociodemographics, walking treatment beliefs and intention (Theory of Planned Behaviour), illness perceptions (Revised Illness Perceptions Questionnaire), and 6MWD. Multiple linear regression was used to evaluate relationships among psychosocial variables (treatment beliefs and illness perceptions) and outcomes (walking intention and 6MWD). Theory of planned behavior constructs were associated with intention (R = .72, p < .001) and 6MWD (R = .08, p < .001). Illness perceptions were associated with 6MWD only (R = .27, p < .001). Intention (β = 0.26), treatment control (β = -0.27), personal control (β = 0.32), coherence (β = 0.18), and risk factor attributions (β = 0.22; all ps < .05) were independently associated with 6MWD. Treatment beliefs and illness perceptions associated with intention and 6MWD in people with intermittent claudication are potential intervention targets.

Illness perceptions in adolescents with chronic fatigue syndrome and other physical health conditions: Application of the common sense model

BACKGROUND

The common sense model (CSM) proposes that illness perceptions guide coping and illness management, which subsequently affects outcomes. Chronic fatigue syndrome (CFS) is associated with severe functional impairment. CFS is distinct from other physical health conditions in that individuals can experience high levels of uncertainty, stigma and disbelief from others. This study aimed to compare illness perceptions in adolescents with CFS with other physical health conditions, using a cross-sectional, between-groups design.

METHODS

Adolescents (aged 11-18) with CFS (n = 49), type 1 diabetes (n = 52) and juvenile idiopathic arthritis (n = 42) were recruited through National Health Service (NHS) clinics and online, and completed a series of questionnaires.

RESULTS

Adolescents with CFS differed on the perceived consequences, timeline, personal control, treatment control, identity and understanding dimensions of illness perceptions. Except for identity, these dimensions were predicted by health condition even when accounting for age, gender, fatigue, physical functioning, anxiety and depression.

CONCLUSIONS

Results offer preliminary evidence for the applicability of the CSM in adolescents, with implications for supporting adolescents with physical health conditions. Results suggest that psychological interventions targeting perceived control, understanding and identity may have particular utility for adolescents with CFS.

Using Different Expectation Mechanisms to Optimize Treatment of Patients With Medical Conditions: A Systematic Review

OBJECTIVE

Patients' expectations have been shown to predict the course and treatment success of a variety of medical conditions. Therefore, expectation-focused psychological interventions (EFPIs) have been developed to use these expectation effects clinically. Importantly, EFPI differ with regard to the particular expectation mechanism being addressed, i.e., expectation optimization or expectation violation. The aims of this systematic review were to give an overview of the application of these expectation interventions and to evaluate their effectiveness.

METHODS

Several databases were searched to identify clinical trials or experimental studies that conducted EFPI among participants with various medical conditions. Risk of bias was evaluated using the Cochrane Risk of Bias tool.

RESULTS

Eleven studies (N = 944) investigating different medical conditions (coronary heart disease, cancer, chronic pain) were included. Qualitative synthesis revealed positive effects of EFPI on clinical outcome variables in all studies. Expectation optimization approaches yielded particularly promising results. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible.

CONCLUSION

This review highlights the potential of EFPI for optimizing treatment of patients with medical conditions. However, it seems that different expectation mechanisms might have different application possibilities. Therefore, we provide suggestions for further developing EFPI to tailor treatment and develop personalized psychological interventions. We argue that for this purpose, it is important to consider both disease-specific aspects and patients' personality traits. In addition, we discuss future challenges such as implementing EFPI into routine medical care.

Illness perception and high readmission health outcomes

This review identified associations between illness perception and health outcomes of patients with a medical diagnosis included in the Hospital Readmissions Reduction Program. Inclusion criteria were English language, use of quantitative methodology, health outcomes specified, and identifiable effect size and statistical significance of the relationship. Most of the 31 studies in this review showed that favorable illness perception has been associated with better health outcomes, while unfavorable illness perception has been associated with worse outcomes. A multifaceted approach might include behavioral, clinical, educational, and psychosocial components to improve one’s illness perception through educative, cognitive-behavioral, or psychodynamic counseling.

Relationships between illness representations, physical activity and depression in chronic kidney disease

BACKGROUND

Chronic Kidney Disease (CKD) is exacerbated by depression and confers significant healthcare costs. Whilst adverse impacts may be mitigated by physical activity, many patients with CKD remain physically inactive, with this physical inactivity potentially influenced by how CKD is appraised.

OBJECTIVES

The study aims to explore the relationship between physical activity, depression and illness representations in CKD.

METHODS

Patients with CKD but not requiring dialysis completed the Revised Illness Perception Questionnaire (IPQ-R), Beck Depression Inventory (BDI-II) and Short-Form International Physical Activity Questionnaire (IPAQ-SF). Demographic information was obtained via medical records. Correlation and regression analyses were conducted to determine the relationship of illness representations with levels of physical activity. Moderation and mediation analyses were performed to investigate the role of depression in any relationship between illness representations and physical activity levels.

RESULTS

Seventy respondents, 60 % male, with a mean age of 60 ± 16 years, took part in the study. Of illness representation dimensions, personal control was positively associated with levels of physical activity whilst timeline cyclical (a subscale of the IPQ-R relating to patient beliefs about the nature of their illness) was a significant predictor. Severity of depression was neither a moderator nor a mediator of illness representations and levels of physical activity.

CONCLUSION

Facets of illness representations had significant relationships with levels of physical activity. Future research concerning the development and validation of psychological interventions based on an illness representations framework for patients with CKD not requiring dialysis is proposed. The efficacy of such interventions could be then evaluated using a randomised controlled method.

The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD

Anxiety is a highly prevalent psychological comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has detrimental effects on pulmonary rehabilitation (PR) outcomes. It has been suggested that disease-specific fears could play an even more important role in COPD patients' disease progression. However, little is known about how different disease-specific fears impact COPD. This study examined how different disease-specific fears relate to different PR outcome measures in COPD patients and how these relationships evolve over the course of PR. Before and after a 3-week inpatient PR program, COPD patients (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears (fear of physical activity, fear of dyspnea, fear of disease progression, fear of social exclusion) were assessed with the COPD-Anxiety-Questionnaire-Revised. Health-related quality of life (HQoL), COPD health status, dyspnea in daily life, depression, and anxiety were measured using validated questionnaires. Multiple regression showed that greater disease-specific fears at the start of PR were associated with worse functional exercise capacity, HQoL, health status, and depression at the start and end of PR (controlling for age, sex, lung function, smoking status, and general anxiety). Patients who showed a stronger decrease in disease-specific fears improved more in PR outcome measures over the course of PR. Furthermore, different disease-specific fears were related to different PR outcome measures. The results show that disease-specific fears are associated with treatment outcome measures, both cross-sectionally and prospectively. Therefore, disease-specific fears should be addressed in COPD patients as they might play a significant role in disease progression.

Cognitive and Perceptual Factors, Not Disease Severity, Are Linked with Anxiety in COPD: Results from a Cross-Sectional Study

PURPOSE

Guided by the Transactional Model of Stress and Coping, the purpose of this cross-sectional study was to examine clinical factors-demographics, chronic obstructive pulmonary disease (COPD) severity, cognitive/perceptual variables (appraisal and coping)-and their relationship to clinically elevated symptoms of anxiety in a sample of veterans with COPD.

METHOD

Participants included a sample of veterans with COPD, with or without comorbid congestive heart failure, and clinically significant symptoms of anxiety (n = 172, mean age = 65.3, SD = 8.1), who previously presented to an outpatient VA setting. Participants completed questionnaires examining COPD severity (respiratory impairment and dyspnea- and fatigue-related quality of life); perceptions of a stressor (COPD illness intrusiveness); perceptions of control (locus of health control, mastery over COPD, self-efficacy); coping strategies (adaptive and maladaptive); and anxiety and depressive symptoms.

RESULTS

Multivariable linear regressions revealed that anxiety was positively associated with more maladaptive coping and locus of control (attributed to other people), above and beyond disease severity, demographics, and depressive symptoms.

CONCLUSION

These findings suggest that cognitive and perceptual factors are concurrent with anxiety; however, longitudinal investigations are needed to fully understand this relationship. Future research should also focus on identifying optimal assessment and treatment procedures when evaluating and treating patients with COPD and symptoms of anxiety.

TRIAL REGISTRATION

NCT01149772.

Perceptions of Hematopoietic Stem Cell Transplantation and Coping Predict Emotional Distress During the Acute Phase After Transplantation

PURPOSE/OBJECTIVES

To test whether a widely used model of adjustment to illness, the self-regulatory model, explains the patterns of distress during acute hematopoietic stem cell transplantation (HSCT). According to the model, perceptions of HSCT, coping, and coping appraisals are associated with distress.
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DESIGN

Longitudinal, correlational.
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SETTING

The Centre for Clinical Haematology at Nottingham City Hospital and the Department of Haematology at Royal Hallamshire Hospital in Sheffield, both in the United Kingdom.
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SAMPLE

45 patients receiving mostly autologous transplantations for a hematologic malignancy.
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METHODS

Patients were assessed at baseline, on transplantation day, and two and four weeks after transplantation using three questionnaires.

MAIN RESEARCH VARIABLES

Psychological distress, including depression, anxiety, stress, and overall distress (DASS-21); use of different coping styles (Brief COPE); and perceptions of HSCT and coping appraisals (Brief IPQ).
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FINDINGS

As suggested by the self-regulatory model, greater distress was associated with negative perceptions of HSCT, controlling for the effects of confounding variables. Mixed support was found for the model's predictions about the impact of coping styles on distress. Use of active and avoidant coping styles was associated with more distress during the acute phase after HSCT.
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CONCLUSIONS

Negative perceptions of HSCT and coping contribute to psychological distress during the acute phase after HSCT and suggest the basis for intervention.
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IMPLICATIONS FOR NURSING

Eliciting and discussing patients' negative perceptions of HSCT beforehand and supporting helpful coping may be important ways to reduce distress during HSCT.

The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care

The new COPD-GRIP (Chronic Obstructive Pulmonary Disease - Guidance, Research on Illness Perception) intervention translates evidence regarding illness perceptions and health-related quality of life (HRQoL) into a nurse intervention to guide COPD patients and to improve health outcomes. It describes how to assess and discuss illness perceptions in a structured way. This study aimed to assess the effectiveness of the intervention in primary care. A cluster randomised controlled trial was conducted within 30 general practices and five home-care centres, including 204 COPD patients. 103 patients were randomly assigned to the intervention group and 101 patients to the usual-care group. To assess differences, repeated multilevel linear mixed modelling analyses were used. Primary outcome was change in health status on the Clinical COPD Questionnaire (CCQ) at 9 months. Secondary outcomes were HRQoL, daily activities, health education impact and changes in illness perceptions. There was no significant difference between the groups in the CCQ at 9 months. We found a significant increase in health-directed behaviour at 6 weeks (p=0.024) and in personal control (p=0.005) at 9 months in favour of the intervention group. The COPD-GRIP intervention, practised by nurses, did not improve health status in COPD patients in primary care. However, the intervention has benefits in improving the ability to control the disease and health-related behaviours in the short term. Therefore, taking illness perceptions into account when stimulating healthy behaviours in COPD patients should be considered. Further study on influencing the health status and HRQoL is needed.

The Common Sense of Counseling Psychology: Introducing the Common-Sense Model of Self-Regulation

The goal of therapy is typically to improve clients' self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client's self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal's Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we propose it may also be useful to understand self-management of mental health problems. The Common-Sense Model's strengths-based perspective is a natural fit for the work of counseling psychologists. In particular, the model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.

With the strength to carry on

People with chronic obstructive pulmonary disease (COPD) are affected by somatic as well as psychological symptoms such as anxiety and depression and reduced quality of life. Protective psychological factors exist which enable people to adapt successfully to disease, but research about these factors in COPD is sparse. The aim of this study was to investigate whether sense of coherence (SOC), resilience and social support are potential protective factors and thus associated with reduced levels of symptoms of anxiety and depression and lower perceived disability in people with COPD. An online study was conducted in which n = 531 participants with COPD completed questionnaires assessing protective psychological factors, anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) and disease-specific disability (COPD Disability Index). Regression analyses were conducted. SOC and resilience contributed significantly to reduced levels of symptoms of anxiety and depression and to lower disease-specific disability after controlling for confounding variables and disease severity. Symptoms of anxiety and depression were most strongly predicted by SOC. This study's results indicated that SOC and resilience could represent helpful individual resources due to their protective potential helping people adjust to COPD. Limitations and implications of this study are discussed.

How do patients conceptualize chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, yet even at risk or diagnosed patients misunderstand COPD and its consequences for their quality of life and mortality. This study explored how patients conceptualize the causes, symptoms, consequences, treatment, and risk for developing COPD. The study consisted of six focus groups: 39 participants who were adults > 40 and current smoker or have COPD symptoms, family history, or exposures. Although many participants had some familiarity with the breathing, lung function, physical, emotional, and social consequences of COPD, confusion and misunderstanding prevailed. Few knew that COPD, chronic bronchitis, and emphysema are synonymous. Some participants claimed that they "only" had bronchitis and/or emphysema and not COPD. Some participants described behavioral adaptations to decrease symptom impact and others expressed strong interest in learning how to increase daily functioning. Insufficient knowledge and persisting misconceptions about COPD can prevent patients from accessing life-enhancing strategies. Patients can benefit from (1) providers clarifying COPD's connection to chronic bronchitis and emphysema to aid them in recognizing the need for mitigating action; (2) encouraging smoking cessation, specifically to stem worsening of disease; and (3) explaining lifestyle adaptations for easing daily life despite decreased lung function.

Illness perceptions and coping with disease in chronic obstructive pulmonary disease: Effects on health-related quality of life

This study investigated the effects of illness perceptions and coping with disease on health-related quality of life in chronic obstructive pulmonary disease. Therefore, participants ( N = 444) completed online questionnaires assessing illness severity (chronic obstructive pulmonary disease stage), Illness Perceptions Questionnaire, coping with disease (Essener Coping Questionnaire), and health-related quality of life (short form-12). Hierarchical regression and moderation analyses were conducted. The results showed that health-related quality of life was predicted by illness perceptions and several aspects of coping with disease. The association between illness perceptions and health-related quality of life was mediated by the corresponding coping with disease subscales. It is concluded that in order to prevent decreasing health-related quality of life in chronic obstructive pulmonary disease, treatment may be adjusted by promoting coping with disease and functional illness perceptions.

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

OBJECTIVE

Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal's common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

METHODS

Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the 'KKG questionnaire for the assessment of control beliefs about illness and health'. Multiple linear regressions were calculated.

RESULTS

The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

CONCLUSION

Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.

How do people live life successfully with Parkinson's disease?

AIMS AND OBJECTIVES

The aim of this paper is to explore how people live life successfully with Parkinson's disease and what contributed to the level of success.

OBJECTIVES

To examine the level of success as defined by people with Parkinson's disease. To find what contributed to the level of success.

BACKGROUND

Self-care support has gained importance for supporting people with their chronic diseases including Parkinson's disease. Although self-care and life adjustments can improve patients' general well-being, it is unclear which approaches best facilitate positive adjustments to illness.

DESIGN

Semi-structured interviews with participants with Parkinson's disease.

METHODS

Eight participants living with Parkinson's disease for 2-16 years were recruited from a Parkinson's disease voluntary group in the UK. Interviews covered their perceived level of success and the factors which they perceived led to that success. Thematic analysis was used to analyse the data.

RESULTS

Participants rated a high level of success in living with Parkinson's disease with an average personal rating 75/100 despite facing difficulties. Successful living was perceived to have taken place when people were either (1) able to return to their usual state of health or (2) considered themselves to be stable within a new/readjusted state of health. Aspects which were perceived to support positive psychosocial adjustment included a positive mindset, determination, acceptance of new challenges and family support.

CONCLUSION

Maintaining usual life and physical ability is the major concern among the people with Parkinson's disease. It would be helpful for health care professionals to identify what constitutes a 'usual' life for that person and to support them to develop a positive mindset and acceptance of new challenges, drawing on the determination of the person as well as any available family support.

RELEVANCE TO CLINICAL PRACTICE

In supporting self-care, it is helpful to gain information about the subjective experience of living with Parkinson's disease including their perceived level of success at the time and what led to that perceived success for that person.

The contribution of illness perception to psychological distress in heart failure patients

BACKGROUND

The influences on the psychological well-being of heart failure (HF) patients have received limited attention. Illness perceptions are a specific set of cognitive representations that have been shown to predict health-related outcomes in other patient groups. This study sought to explore the role of illness perceptions in the psychological well-being of HF patients by creating a profile of illness perceptions in HF and examining their relations with anxiety and depression.

METHODS

Participants were 95 consecutive outpatients. Indices of psychological well-being were depression and anxiety, measured using the Hospital Anxiety and Depression Scale (HADS). Illness perceptions were measured using the Illness Perception Questionnaire - Revised (IPQ-R). Functional status was also determined using the New York Heart Association (NYHA) classification.

RESULTS

Illness perceptions were associated with indices of psychological well-being. Regression analyses showed that illness perceptions accounted for a significant proportion of the variance in both depression and anxiety. The contribution of illness perceptions was greater than that made by traditional covariates (socio-demographic variables and functional status).

CONCLUSIONS

Results highlight dynamic interrelations between perceptions of illness and mental health indices. They also suggest that in considering the role of illness perceptions in psychological well-being, the primary focus should be on the overall dynamic of an individual's illness experience rather than on specific illness dimensions. Findings highlight the potential role of illness perceptions in depression and anxiety in HF. This has implications for interventions to maximise psychological well-being in this patient group.

Perceived quality of life in chronic obstructive pulmonary disease patients: a cross-sectional study in primary care on the role of illness perceptions

BACKGROUND

Previous research has shown that in Chronic Obstructive Pulmonary Disease (COPD) patients, it is important to consider not only physical functioning and complaints but also psychological factors, such as illness perceptions, to explain differences in Health-Related Quality of Life (HRQoL). The objective of this study is to analyse the extent to which the specific dimensions of illness perceptions according to the Common Sense Model (corrected for airflow limitation, dyspnoea and comorbidities) contribute to HRQoL.

METHOD

In a cross-sectional study in primary care, 90 COPD patients completed questionnaires: The Brief Illness Perception Questionnaire, the Medical Research Council dyspnoea scale, the Clinical COPD Questionnaire (CCQ) and the Chronic Respiratory Questionnaire (CRQ). Analyses were performed with multiple linear regression.

RESULTS

When corrected for confounders (airflow limitation, dyspnoea and comorbidities), identity (β = .42) and comprehensibility (β = -.16) were associated with HRQoL (CCQ). Identity, comprehensibility and dyspnoea explained 56% of the variation in HRQoL (R2 = .56). Consequences (β = -.50) and treatment control (β = .20) were associated with HRQoL (the CRQ's physical domain). They explained 59% of the variation in the CRQ physical (R2 = .59) domain. Treatment control (β = .19) and emotional response (β = -.33) were associated with the CRQ emotional domain.

CONCLUSIONS

Patients who experience fewer symptoms attributed to COPD, who have a better understanding of the disease, who experience less impact of COPD in daily life, who experience better treatment control and who have less of an emotional response have better HRQoL. This study indicates that the HRQoL of COPD patients is associated with illness perceptions as well as with the severity of dyspnoea as experienced by patients. Airflow limitation measures or comorbidities do not add to the explanation of HRQoL. The results of this study provide starting points for the development of interventions focusing on illness perceptions to support COPD patients in their disease management and to improve HRQoL.