Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect

Illness perceptions in relation to self-management behaviour among elderly patients with COPD: A cross-sectional study

AIMS

The purpose of this study was to investigate the status of self-management behaviour and illness perceptions and to examine illness perceptions in relation to self-management behaviour in elderly patients with chronic obstructive pulmonary disease (COPD).

METHODS

A cross-sectional study was conducted, and 152 elderly COPD patients were recruited via the convenience sampling method. The COPD Self-Management Scale and the Revised Illness Perception Questionnaire for COPD patients were used to examine self-management behaviour and illness perceptions. Pearson correlation analysis, univariate analysis and hierarchical linear regression analysis were used to explore illness perceptions in relation to self-management behaviour.

RESULTS

The mean overall score for self-management behaviour was 2.90 ± 0.39. Among the subscales of self-management behaviour, information management had the lowest score of 2.20 ± 0.76. Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be significant determinants of self-management behaviour. After controlling for these variables, several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self-management behaviour.

CONCLUSIONS

This study confirmed that elderly COPD patients' self-management behaviour was unsatisfactory and that illness perceptions were significant determinants of self-management behaviour. The findings may contribute to the development of self-management interventions for elderly COPD patients.

The Relationship Between Benefit Finding and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Mediating Effects of Self-Management

Objective

To explore the relationships among benefit finding (BF), self-management, and quality of life (QOL) among patients with COPD.

Methods

A total of 205 patients with COPD were selected via a convenient sampling method. BF refers to the ability to find meaning or benefit from difficult situations. The Benefit Finding Scale (BFS), self-management scale, and 36-item Short-Form Health Survey (MOS SF-36) were used to investigate BF, self-management and QOL (including a physical component summary (PCS) and a psychological component summary (MCS)). Structural equation modeling was used to examine the relationships among BF, self-management and QOL in patients with COPD and to analyze the effects of BF and self-management on QOL.

Results

The total QOL score of patients with COPD was 61.38±21.15, and the PCS and MCS scores were 57.67±23.60 and 65.09±21.24, respectively. BF and self-management had positive predictive effects on both the PCS (βBF = 0.519, PBF = 0.012; βself-management = 0.473, Pself-management = 0.012) and MCS (βBF = 0.425, PBF = 0.013; βself-management = 0.535, Pself-management = 0.016) of patients with COPD, and self-management mediated the relationships of BF with the PCS (β = 0.144, P = 0.008) and MCS (β = 0.162, P = 0.007).

Conclusion

The QOL of patients with COPD needs to be improved, especially in terms of physical aspects. Helping COPD patients obtain better BF not only helps them improve their PCS and MCS directly but also indirectly through enhancing self-management to improve their PCS and MCS.

Revolutionizing Chronic Obstructive Pulmonary Disease Care with the Open AI Application: ChatGPT

Chronic Obstructive Pulmonary Disease (COPD) is one of the major and leading threats to human being. To cope with this health challenge, several studies have been undertaken in the literature. However, COPD is not paid close attention to eliminate it entirely. The current study aims to examine the role of ChatGPT application to bring improvement in controlling and managing COPD in patients. ChatGPT is used to give prompt answers of text-based questions in a variety of fields. It has potential role in knowing the symptoms of COPD, and letting individuals to modify their life styles. ChatGPT suggests medications for COPD individuals based on the established medical guidelines. Compared to the literature, ChatGPT provides a comprehensive list of COPD test and evaluation methods. ChatGPT has the potential to help physicians to take decisions in diagnosing, treating, and managing COPD among individuals in its upcoming versions. More researches can be conducted to identify the limits of ChatGPT application in future works.

A Mixed Methods Evaluation of a Pilot Multidisciplinary Breathlessness Support Service

Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires (n = 10), medical record audit (n = 14) and a post-discharge interview (n = 8). Caregivers (n = 1) and healthcare professionals involved in referral to (n = 2) and delivery of (n = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.

Adding Granularity of COPD Self-Management to Impact Quality of Life

BACKGROUND

Self-management abilities are a recognized ingredient for living well with chronic obstructive pulmonary disease (COPD), improving all outcomes. Fostering self-management requires a personalized program and patient engagement to make lifestyle decisions. While some self-management practices are proven effective, like the prompt use of a plan for COPD exacerbations, there is a guideline-recognized gap on specific self-management behaviors that can impact particular COPD symptoms and allow for tailored self-management programs. We aimed to investigate the association of well-defined self-management behaviors with the most common COPD symptoms in a large cohort of patients with COPD.

METHODS

We analyzed baseline data of stable COPD patients who participated in 3 National Institutes of Health-funded studies. Symptoms were defined by the 4 domains of the Chronic Respiratory Questionnaire: dyspnea-fatigue-emotions-mastery. The self-management behaviors were the individual items of the Self-Management Ability Scale-30. Lasso regression models were built to explore the association of behaviors with symptoms, adjusting for lung function and age.

RESULTS

We analyzed 512 stable COPD patients, 54% female, age mean (standard deviation [SD]) 69.6 (9.9) years and forced expiratory volume in 1 second percent predicted (FEV₁%) 42.2 (19.0).Dyspnea was associated with exercising and self-efficacy for self-care. Emotion was associated with good relationships, self-efficacy for self-care, positivity, and participating in agreeable activities. Fatigue was associated with self-efficacy for self-care, doing exercise, and participating in agreeable activities. Mastery was associated with self-efficacy for self-care, positivity, exercising, and participating in agreeable activities.

DISCUSSION

Our findings provide specific self-management behaviors associated with common COPD symptoms that may inform self-management programs. Positive thinking represents a novel self-management approach to COPD emotions and mastery.

Using self-determination theory to predict self-management and HRQoL in moderate-to-severe COPD

Objective: Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition that detrimentally affects health-related quality of life (HRQoL), with self-management proposed as an effective treatment. Using self-determination theory (SDT), this research explored psychological need satisfaction, frustration, and behavioural regulation to explain indicators of self-management.

Design and Main Outcome Measures: Cross-sectional, questionnaire-based methods in people on a pulmonary rehabilitation waiting-list. 72 participants completed SDT, HRQoL, and self-management knowledge questionnaires. Path analyses investigated the ability of SDT concepts to predict self-management knowledge and HRQoL.

Results: Chi-square tests found no significant differences (χ²(13, N=72) = 16.7, p > 0.05) between the just – and over-identified models, and multiple measures suggested an acceptable fit to the data. Relatedness frustration positively predicted controlled regulation and autonomy and relatedness satisfaction positively predicted autonomous regulation. The associations between the other needs and the different regulation types were not statistically significant. Both regulation types strongly predicted HRQoL (35% variance explained) and self-management knowledge (22% variance explained).

Conclusion: SDT concepts can predict more self-determined self-management regulation, self-management knowledge, and HRQoL and provide a framework for researchers and healthcare professionals to develop future health interventions for people with COPD. Greater research is needed to understand basic psychological need frustration in health contexts.

2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

Background

An important but often insufficient aspect of care in people with inflammatory arthritis (IA) is empowering patients to acquire a good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Self-management skills can be helpful in this regard.

Objectives

To develop recommendations for the implementation of self-management strategies in IA.

Methods

A multidisciplinary taskforce of 18 members from 11 European countries was convened. A systematic review and other supportive information (survey of healthcare professionals (HCPs) and patient organisations) were used to formulate the recommendations.

Results

Three overarching principles and nine recommendations were formulated. These focused on empowering patients to become active partners of the team and to take a more proactive role. The importance of patient education and key self-management interventions such as problem solving, goal setting and cognitive behavioural therapy were highlighted. Role of patient organisations and HCPs in promoting and signposting patients to available resources has been highlighted through the promotion of physical activity, lifestyle advice, support with mental health aspects and ability to remain at work. Digital healthcare is essential in supporting and optimising self-management and the HCPs need to be aware of available resources to signpost patients.

Conclusion

These recommendations support the inclusion of self-management advice and resources in the routine management of people with IA and aim to empower and support patients and encourage a more holistic, patient-centred approach to care which could result in improved patient experience of care and outcomes.

The Effect of Nursing Care Applied to Patients with Chronic Obstructive Pulmonary Disease on Their Sexual Experiences and Quality of Life

This study was conducted for the aim of assessing the effect of nursing care applied to patients with chronic obstructive pulmonary disease on their sexual experiences and quality of life. The sample of the study was determined via power analysis, patients were assigned groups using a simple random sampling method. The data were collected between December 2019-June 2020. The researcher applied the nursing care to patients in the experimental group in their home three times. There was a statistically significant difference between posttest mean scores of the Short Form-36 Health-Related Quality of Life Questionnaire subscales and Arizona Sexual Experiences Scale of the patients in the experimental and control groups (p < 0.05). In this study, it was determined that there was an increase in the Health-Related Quality of Life Questionnaire mean score of patients with COPD after the nursing care; whereas, there was a slight decrease in the Arizona Sexual Experiences Scale mean score.

Patient-reported quality of life in fibrotic interstitial lung disease: novel assessments of self-management ability and affect

Current medical therapy in the treatment of fibrotic interstitial lung disease (f-ILD) is focused on objective improvement or stabilisation of lung function decline as represented by raw or per cent predicted forced vital capacity (FVC % pred). Patient-reported quality of life (PR-QoL) outcomes, as measured from the viewpoint of how patients assess their own health-related well-being, have not been the primary targets of recent clinical trials. However, it has been reported that lung function (i.e. measured FVC % pred) in f-ILD correlates poorly with patient-reported well-being [1]. This study explored the degree to which two previously unassessed PR-QoL outcomes in f-ILD correlate with clinical and functional parameters, and a respiratory-related QoL instrument applied in a novel manner.

Patient-reported outcomes in fibrotic interstitial lung disease may be additionally predicted by novel assessments of self-management ability and affecthttps://bit.ly/3iwP5M2

Assessing the uptake, engagement, and safety of a self-management app, COPD.Pal®, for Chronic Obstructive Pulmonary Disease: a pilot study

Chronic Obstructive Pulmonary Disease (COPD) is a widespread condition that accounts for 3 million deaths worldwide annually. Despite being extensive healthcare users, people with COPD (PwCOPD) only spend approximately 1% of their time with a healthcare professional. The rest of the time, they are encouraged to self-manage their condition. To encourage better self-management, Bond Digital Health have created a mobile phone app called COPD.Pal® that helps PwCOPD keep track of their condition. This pilot study aimed to assess the safety, engagement, and early efficacy of the app. 25 PwCOPD were recruited and given COPD.Pal® for 6-weeks. Healthcare usage, self-management knowledge, app engagement, dyspnoea, and health-related quality of life were measured at baseline and at 6-weeks. A feedback questionnaire was also collected at follow-up. T-tests investigated whether differences between the time points were evident in the data. No statistically significant differences were found between the time points for any of the variables measured. Average app engagement was 31.8 days with 84% using COPD.Pal® for 20 or more days during the 6-weeks. 89% of participants stated they would use the app regularly after the study, with 56% stating they’d use it long-term. This study determined that a digital, self-management app would be engaged with and early results indicate that the safety is non-inferior to standard care. Although self-management knowledge remained unaffected by app use, this study provided useful insights regarding how to improve this aspect. This represents one of few studies which involve end-users at an early stage of intervention development, an important strength of the research.

A Hybrid Model to Classify Patients with Chronic Obstructive Respiratory Diseases

Over the last decades, an increase in the ageing population and age-related diseases has been observed, with the increase in healthcare costs. As so, new solutions to provide more efficient and affordable support to this group of patients are needed. Such solutions should never discard the user and instead should focus on promoting more healthy lifestyles and provide tools for patients’ active participation in the treatment and management of their diseases. In this concern, the Personal Health Empowerment (PHE) project presented in this paper aims to empower patients to monitor and improve their health, using personal data and technology assisted coaching. The work described in this paper focuses on defining an approach for user modelling on patients with chronic obstructive respiratory diseases using a hybrid modelling approach to identify different groups of users. A classification model with 90.4% prediction accuracy was generated combining agglomerative hierarchical clustering and decision tree classification techniques. Furthermore, this model identified 5 clusters which describe characteristics of 5 different types of users according to 7 generated rules. With the modelling approach defined in this study, a personalized coaching solution will be built considering patients with different necessities and capabilities and adapting the support provided, enabling the recognition of early signs of exacerbations and objective self-monitoring and treatment of the disease. The novel factor of this approach resides in the possibility to integrate personalized coaching technologies adapted to each kind of user within a smartphone-based application resulting in a reliable and affordable alternative for patients to manage their disease.

The Manchester Respiratory Activities of Daily Living Questionnaire: Reliability and Validity of the Chinese Version with Pictorial Enhancement

Background

The Manchester Respiratory Activities of Daily Living Questionnaire (MRADLQ) is a valid and reliable tool measuring the functional level of patients with COPD in multidimensional aspects. However, a local validation of the questionnaire is lacking in Hong Kong.

Objective

To develop a Chinese version of MRADLQ with pictorial enhancement (C-MRADLQ) and study its reliability and validity.

Patients and Methods

A total of 238 patients suffering from COPD were recruited from nine public hospitals and five Nurse and Allied Health Respiratory Clinics by convenient sampling. A total of 64 patients with normal spirometry results and no previous clinical diagnosis of COPD were invited to complete the C-MRADLQ for comparison and examination of its validity. Ten out of 302 patients were re-assessed with the C-MRADLQ after one week by the same rater for test–retest reliability. The C-MRADLQ was correlated with spirometry result, COPD classifications and groups by Global Initiative for Chronic Obstructive Lung Disease (GOLD), the modified Medical Research Council Dyspnea Scale (mMRC Dyspnea Scale), COPD Assessment Test (CAT), Chinese Version of the Shortness of Breath Questionnaire (C-SOBQ), number of admission and the ADO index.

Results

The C-MRADLQ shows good test–retest reliability as indicated by an intra-class correlation coefficient value of 0.975. It is significantly correlated with COPD stage, COPD group, SOBQ score, CAT score, mMRC, ADO index, spirometry results, and number of admissions. The SOBQ score, number of admissions, FEV1/FVC, and COPD group could significantly predict the total C-MRADLQ score. A total of 67.9% of participants’ mMRC levels were correctly classified by using the C-MRADLQ total score. The agreement of the original and new versions of questions 20 and 21 of C-MRADLQ was 97.3% and 90.1%, respectively.

Conclusion

The pictorial version of the C-MRADLQ is a validated and reliable functional assessment tool to measure functional status among patients with COPD in the Chinese population.

Using the Technology Acceptance Model to conceptualise experiences of the usability and acceptability of a self-management app (COPD.Pal®) for Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a long-term progressive inflammatory lung disease causing chronic breathlessness and many hospital admissions. It affects up to 1.2 million people in the UK. To help people with COPD self-manage their condition we developed, in partnership with healthcare users, a digital mobile phone app called COPD.Pal®. We report the first user feedback of COPD.Pal®, applying the Technology Acceptance Model (TAM) theoretical framework.

11 participants engaged with a click dummy version of COPD.Pal® before being asked questions relating to their experiences. A deductive, semantic, reflexive thematic analysis was conducted to analyse their individual and collective experiences. The study was registered at Clinical Trials.gov (NCT04142957).

Two overarching themes resulted: Ease of Use and Perceived Usefulness. Within the former, participants discussed how they wanted flexibility and choice in how they engaged with the app; including how often they used it. Additionally, they discussed how the app layout should make it straightforward to use, whilst unanimously agreeing that COPD.Pal® provided this. Within Perceived Usefulness, participants discussed how they wanted the information they entered into the app to be useful, in addition to the app providing resources regarding COPD. Lastly, there was disagreement regarding preferences for further app development.

We found that COPD.Pal® was usable and acceptable by people with COPD and TAM provided a useful theoretical framework for both structuring discussions with users and analysing their comments.

The development of a behaviour questionnaire for stoma self-management for persons with bladder cancer and an ileal conduit

AIMS

To develop and preliminarily test the reliability and validity of a behaviour questionnaire for stoma self-management for patients with bladder cancer after radical cystectomy and ileal conduit.

DESIGN

A psychometric instrument validation study conducted in two phases.

METHODS

The initial version of behaviour questionnaire was developed based on guidelines for people living with a stoma. Five experts validated the content of the preliminary 29-item questionnaire. A cross-sectional survey was then conducted in Beijing for preliminary reliability and validity tests between 4 December 2017-28 April 2018. A total of 151 participants in the survey, 147 of whom completed the study and 16 completed a 2-week test-retest reliability test.

RESULTS

The content validity indices were satisfied. A principal component analysis with direct oblimin rotation was performed. Sixteen items were retained, and three factors were identified, namely, pouching system change, emotional management, and role management. The 16-item questionnaire showed acceptable internal consistency and test-retest reliability. The mediational effect of self-management behaviour on the relationship between self-efficacy and stoma quality of life was confirmed via convergent validity testing.

CONCLUSION

The behaviour questionnaire for stoma self-management appears to have adequate initial reliability and validity. More observational and interventional studies need to be conducted for further evaluation of its psychometric properties.

IMPACT

This study developed a reliable instrument to measure self-management behaviours for persons living with a stoma after radical cystectomy and ileal conduit. The questionnaire has practical value for both healthcare providers and researchers working in this field. The 16-item questionnaire can be administered quickly in clinical practice. Based on the questionnaire and the elicited mediational model, psycho-education programs tailored to improve self-management should be designed, implemented, and re-inspected regarding their effectiveness for the target population in China.

Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study

Objective: To determine the feasibility of implementing and evaluating a self-management mobile app for spinal cord injury (SCI) during inpatient rehabilitation and following community discharge. Design: Pilot feasibility study. Setting: Rehabilitation hospital and community. Participants: Inpatients from rehabilitation hospital following admission for their first SCI. Intervention: A mobile app was developed to facilitate self-management following SCI. The app consisted of 18 tools focusing on goal setting, tracking various health aspects, and identifying confidence regarding components of self-management. In-person training and follow-up sessions were conducted during inpatient rehabilitation and follow-up calls were provided after participants were discharged into the community. Main outcome measures: Participants completed outcome measures at baseline, community discharge, and 3-months post discharge. This study focused on feasibility indicators including recruitment, retention, respondent characteristics, adherence, and app usage. Additionally, participants' self-management confidence relating to SCI (e.g. medication, skin, bladder, pain) was evaluated over time. Results: Twenty participants (median age 39, IQR: 31 years, 85% male) enrolled in the study. Participants' Spinal Cord Injury Independence Measure (SCIM-III) median score was 23 and IQR was 33 (range: 7-84), which did not correlate with app usage. Retention from admission to discharge was 85% and 70% from discharge to 3-months post discharge. Individuals in the study who used the app entered data an average of 1.7x/day in rehabilitation (n = 17), and 0.5x/day in the community (n = 7). Participants' bowel self-management confidence improved between admission and discharge (P < 0.01). Conclusions: Feasibility indicators support a larger clinical trial during inpatient rehabilitation; however, there were challenges with retention and adherence following community discharge.

A TASMAN Expedition: Development of a Questionnaire to Assess Specific Self-Management Abilities

Introduction

Self-management (SM) is a core component of well-being and perceived health for patients with chronic obstructive pulmonary disease (COPD). Most theories on SM share that self-efficacy, illness-perception and coping are determinants of SM behavior. Optimal support to improve SM should be tailored to the individual patient’s level of these determinants as SM abilities vary between patients. To tailor SM support, it is therefore necessary to assess the scores on these determinants. Unfortunately, no such instrument exists for clinical use. Therefore, the first goal of this study was to verify presumed correlations between SM and the determinants thereof. The second goal was to develop an instrument to assess the SM abilities.

Methods

In this cross-sectional, observational study, COPD patients completed the General Self-Efficacy Scale (GSES), Brief Illness Perception Questionnaire (B-IPQ) and the Utrecht Proactive Coping Competence measure (UPCC) as well as the Self-Management Ability Scale (SMAS-30). Correlations between the questionnaires were assessed and a principal component analysis (PCA) was performed to identify the best-fitting items in the three independent variables related to SM. These items were used to create an instrument to assess SM abilities.

Results

Hundred COPD patients (58 males, 41 females, 1 unknown) were included. The correlation between SM and self-efficacy, illness perception on concerns and proactive coping was moderate and significant (r=0.318, p<0.01; r=−.230, p<0.05; r=.426, p<0.01, respectively). PCA identified six UPCC items and nine GSES items that met the predefined criteria. These items were supplemented with the B-IPQ concerns item to establish the new instrument to assess SM abilities.

Diet and Oral Health Coaching Methods and Models for the Independent Elderly

Health-related behavior based on diet is an important determinant of oral health in independent elderly. Aging impairs senses, mastication, oral status, and function, causing nutritional needs and diet insufficiencies that contribute to a vicious circle of impairment. But the present needs of independent older adults suggest that health research and oral health care should shift from disease management and therapy to integral customized and personal treatment plans, including lifestyle, psychological, nutritional, and oral health coaching approaches. In this paper health coaching approaches in medical and dental settings are valued as to their effectiveness for older adults. Furthermore, coaching approaches for seniors are discussed and coaching models for better senior patient-dentist cooperation on the diet issue are suggested. Diet and oral health coaching is proven to be a modern senior patient-centered approach that needs to be incorporated at all relevant settings. It should aim to empower older adults in co-management of their oral diseases or bad diet habits affecting their oral health. This can be carried out through an incorporated educational plan for dentists either at the postgraduate or professional level since advantages seem to enhance the quality of life of the independent elderly.

Self-Efficacy and Psychological Well-Being in Cardiac Patients: Moderated Mediation by Affect and Meaning-Making

Prior research suggests a potential moderated mediation effect between self-efficacy and psychological well-being. Based on the Meaning Making Model and the Broaden-and-Build Theory, this study examines the relationship between self-efficacy and psychological well-being in the moderated mediation perspective of affect and meaning-making in coronary heart disease patients. The questionnaires measuring self-efficacy, psychological well-being, affect, and meaning-making were used to collect data from one hundred and fifty six patients (73 women and 83 men) who were suffering from coronary heart disease. The patients had a history of coronary heart disease in the previous .1‒7.9 years and were aged 47‒82. Findings demonstrated that meaning-making mediated the indirect relationship between self-efficacy and psychological well-being. In addition, the moderated mediation effect of positive affect, but not of negative affect was significant. Positive affect moderated the indirect effect between self-efficacy and psychological well-being through meaning-making; the indirect effect was stronger when positive affect was high as opposed to low. The results suggest the interplay of affective and meaning-making processes in the relationship between self-efficacy and well-being.

Interventions to Improve the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease: A Global Mapping During 1990-2018

Chronic obstructive pulmonary disease (COPD) has been considered a significant health challenge globally in recent years, which affects different aspects of the quality-of-life (QoL). A review was conducted of research output, research topics, and landscape to have a global view of the papers mentioning the interventions to increase QoL of patients with COPD. A total of 3242 research items from Web of Science during the period 1990-2018 were downloaded and analyzed. Analyses based on the different levels of data and methods using using VOSviewer software tool (version 1.16.15, Centre for Science and Technology Studies (CWTS), Leiden University, Leiden, The Netherlands) and Latent Dirichlet allocation. By exploring the trends in research productivity and topics, an increase was found in the number of papers mentioning non-pharmacological interventions as well as mental health illness and QoL among patients with COPD. In conclusion, the research on the interventions to increase the QoL of patients with COPD has attracted scientists globally. It is suggested that more research should be conducted on the effectiveness of non-pharmacological therapies to increase QoL of patients with COPD that can be applied broadly in the community. The collaboration and support from developed countries to developing countries are needed to increase the QoL of people living with COPD.

Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal

Background

Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals’ quality of life. COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal.

Methods

This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and SMPs was examined using univariate statistics. Multivariable analysis was conducted to identify the factors associated with SMPs.

Results

A total of 238 patients responded to the study. The mean score of SMPQ was 45.31(SD = 9.00). The HLQ and PAM scores were positively correlated with the total score of SMPQ. Low level of SMPs were found to be positively associated with being uneducated (β = − 0.43, p = .001), having a low family income (β = − 5.22, p = .002), and, negatively associated with the presence of more than one co-morbidity (β = 3.58, p = 0.007) after controlling for other socio-demographic variables in the multivariable analysis.

Conclusion

The overall SMPs among this sample of Nepalese with COPD were low. Our findings highlight the need to implement a self-management intervention program involving patient activation and health literacy-focused activities for COPD, creating a support system for patients from low-income families and low education.

Self-management across chronic diseases: Targeting education and support needs

OBJECTIVES

Among Canadian adults with chronic disease: 1) to identify groups that differ in self-management task frequency and self-efficacy; 2) to compare group characteristics and preferences for self-management support.

METHODS

Using data from an online survey, cluster analysis was used to identify groups that differed in self-management task frequency and self-efficacy. Multivariable regression was used to explore relationships with patient characteristics and preferences.

RESULTS

Cluster analysis (n = 247) revealed three groups:Vulnerable Self-Managers (n = 55), with the highest task frequency and lowest self-efficacy; Confident Self-Managers (n = 73), with the lowest task frequency and highest self-efficacy; and Moderate Needs Self-Managers (n = 119), with intermediate task frequency and self-efficacy. Vulnerable Self-Managers, when compared with the Confident group, were more often: on illness-related employment disability or unemployed; less well educated; diagnosed with emotional problems or hypertension, and had greater multimorbidity. They participated less often in self-management programs, and differed in support preferences.

CONCLUSIONS

Knowing the characteristics of vulnerable self-managers can help in targeting those in greater need for self-management support that matches their preferences.

PRACTICE IMPLICATIONS

Different approaches are needed to support self-management in the vulnerable population.

Impact of Affect on Lung Transplant Candidate Outcomes

BACKGROUND

We examined the association of adult lung transplant candidates' self-reported affect with transplant-related outcomes, evaluating whether a positive (vs negative) frame of mind might be protective.

METHOD

Consenting waitlisted candidates from 6 centers completed the questionnaires including the Positive and Negative Affect Schedule annually and posttransplant. Univariate logistic regression analysis was performed to determine the association of baseline affect with outcomes of death or delisting. Models were subsequently adjusted for age, marital status, and education.

RESULTS

Questionnaires were completed by 169 candidates (77.9% participation). Mean positive affect, negative affect, and positive-to-negative affect ratio (positivity ratio) were similar to expected norms. The scores of the questionnaire did not change significantly over time. Fifteen (8.9%) waitlisted participants died. Candidates who died while waiting had lower positivity ratios compared to those who survived (1.82 vs 2.45; P = .02). A more negative affect was associated with increased death on the waiting list (adjusted odds ratio [OR] 1.10; P = .021). Conversely, a higher positivity ratio was associated with decreased death while waiting (adjusted OR: 0.45; P = .027).

CONCLUSION

Negative affect may represent a novel risk factor for death on the waitlist. Enhancing positive affect may represent a useful target for psychological optimization in lung transplant candidates.

[Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors]

PURPOSE

This study aimed to examine the levels of perceived self-management support, self-efficacy for self-management, and health-related quality of life (HRQoL) in cancer survivors, and to identify the mediating effect of self-efficacy in the relationship between perceived self-management support and HRQoL.

METHODS

This study used a descriptive correlational design. Two hundred and four cancer survivors who had completed treatment participated in the study. Measurements included the Patient Assessment of Chronic Illness Care Scale, the Korean version of the Cancer Survivors' Self-Efficacy Scale, and the Medical Outcomes Study Short Form-36. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method for mediation.

RESULTS

The mean score for perceived self-management support was 3.35 out of 5 points, self-efficacy was 7.26 out of 10 points, and HRQoL was 65.90 out of 100 points. Perceived self-management support was significantly positively correlated with self-efficacy (r=.29, p<.001) and HRQoL (r=.27, p<.001). Self-efficacy was also significantly correlated with HRQoL (r=.59, p<.001). Furthermore, self-efficacy (β=.55, p<.001) had a complete mediating effect on the relationship between perceived self-management support and HRQoL (Z=3.88, p<.001).

CONCLUSION

The impact of perceived self-management support on HRQoL in cancer survivors was mediated by self-efficacy for self-management. This suggests that strategies for enhancing self-efficacy in cancer survivors should be considered when developing self-management interventions for improving their HRQoL.

Benefits of the 'village': a qualitative exploration of the patient experience of COPD in rural Australia

OBJECTIVES

This study sought to explore patients' experiences of living with, and adapting to, chronic obstructive pulmonary disease (COPD) in the rural context. Specifically, our research question was 'What are the barriers and facilitators to living with and adapting to COPD in rural Australia?'

DESIGN

Qualitative, semi-structured interviews. Conversations were recorded, transcribed verbatim and analysed using thematic analysis following the COnsolidated criteria for REporting Qualitative research guidelines.

SETTING

Patients with COPD, admitted to a subregional hospital in Australia were invited to participate in interviews between October and November 2016.

MAIN OUTCOME MEASURES

Themes were identified that assisted with understanding of the barriers and facilitators to living with, and adapting to, COPD in the rural context.

RESULTS

Four groups of themes emerged: internal facilitators (coping strategies; knowledge of when to seek help) and external facilitators (centrality of a known doctor; health team 'going above and beyond' and social supports) and internal/external barriers to COPD self-management (loss of identity, lack of access and clear communication, sociocultural challenges), which were moderated by feelings of inclusion or isolation in the rural community or 'village'.

CONCLUSIONS

Our findings suggest that community inclusion enhances patients' ability to cope and ultimately self-manage COPD. This is facilitated by living in a supportive 'village' environment, and included a central, known doctor and a healthcare team willing to go 'above and beyond'. Understanding, or supplementing, these social networks within the broader social structure may assist people to manage chronic disease, regardless of rural or metropolitan location.

The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis

AIM

To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease.

DESIGN

A secondary analysis of semi-structured interview data.

METHODS

Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping.

RESULTS

Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial.

CONCLUSION

This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management.

IMPACT

This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.

Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study

BACKGROUND

Self-management of patients with COPD has received increasing attention in recent years given its association with improved outcomes. There is a scarcity of feasible interventions that can improve self-management abilities. We recently reported the positive effect of health coaching, started at the time of hospital discharge, on re-hospitalizations and emergency department visits for patients with COPD admitted for an exacerbation. In this substudy, we aimed to investigate the effects of health coaching delivered by a respiratory therapist or a nurse compared with guideline-based usual care on self-management abilities in COPD.

METHODS

Self-management was measured by using the Chronic Respiratory Disease Questionnaire mastery domain and was assessed at baseline, at 6 months, and at 12 months after hospitalization.

RESULTS

Two hundred and fifteen subjects hospitalized for a COPD exacerbation were randomized to the intervention or the control. The mean change in the Chronic Respiratory Disease Questionnaire mastery score from baseline to month 6 was Δ0.58 32 ± 1.29 on the intervention arm and Δ0.17 32 ± 1.14 on the control arm (P = .02). Of the intervention subjects, 55% had at least a 0.5-point increase in Chronic Respiratory Disease Questionnaire mastery (minimum clinically important difference) compared with 38% in the control group. Health coaching was an independent predictor of the minimum clinically important difference or greater change in the Chronic Respiratory Disease Questionnaire mastery score at 6 months after initiation of the intervention (odds ratio 1.95, 95% CI 1.01-3.79). The changes in the Chronic Respiratory Disease Questionnaire mastery score at 12 months showed a trend but did not attain statistical significance.

CONCLUSIONS

Health coaching delivered by a respiratory therapist or a nurse improved self-management abilities when applied to subjects with COPD after hospital discharge for an exacerbation. (ClinicalTrials.gov Identifier: NCT01058486, Mayo IRB 09-004341).

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.

Sociodemographic and clinical factors affecting the quality of life of patients with chronic obstructive pulmonary disease

Background

COPD remains a significant challenge for contemporary medicine. It is one of the most common respiratory illnesses and leads to disability as well as deteriorating patient’s quality of life (QOL).

Objective

The objective of this study was to determine the impact of selected sociodemographic and clinical factors on QOL and level of illness acceptance (LIA) of patients with COPD.

Design

This study was a cross-sectional, prospective, observational study.

Patients and methods

The study involved 100 patients (34 women and 66 men) suffering from COPD for at least half a year, treated in the Allergology Clinic at the Department of Internal Medicine, Geriatrics and Allergy, Wroclaw Medical University in Poland. Standardized questionnaires such as Short Form-36 Health Survey, Saint George’s Respiratory Questionnaire, Acceptance of Illness Scale, and COPD Author’s Questionnaire were used to assess QOL and LIA.

Results

Among the most significant results, there were no statistically significant differences between the patients’ sex and their QOL and LIA (P>0.05). It has been observed that with an increase in the age of patients, a statistically significant decrease in LIA is observed, especially after 60 years of age (P=0.001). It was found that the higher level of education of the patients was statistically significant in the higher QOL (P<0.05) and in the greater LIA (P<0.05). Interestingly, there was no statistically significant effect of active smoking and overweight on QOL and LIA (P>0.05).

Conclusion

Sex of COPD patients does not affect their QOL or LIA, nonetheless, the age decreases the level of QOL and LIA. Higher education improves QOL scores; however, factors such as dyspnea, longer duration of illness, comorbidities, oxygen therapy undertaking, and family burden of respiratory disease affect deterioration of QOL.

Detection of early-stage changes in people with chronic diseases: A telehome monitoring-based telenursing feasibility study

Chronic diseases, such as chronic obstructive pulmonary disease, amyotrophic lateral sclerosis, and diabetes mellitus, require long-term management, which daily telenurse monitoring can provide. The aim of the present feasibility study was to determine if using a telenursing protocol with home monitoring during a 12 week implementation could also identify early signs of deterioration and factors correlated with participants' change in status, while attaining patient acceptance and satisfaction. The purposive sample of 43 participants provided 4533 combined days of monitoring. Outcome feasibility indicators were the range of triggering protocol alerts (70~100%) and diagnoses with exacerbations (20~29.3%). Highly correlated were participants' activity limitation and palpitations with chronic obstructive pulmonary disease, activity limitation and ineffective sputum clearance with amyotrophic lateral sclerosis, and fatigue with diabetes. Acceptance and adherence were high with daily monitoring, including "feelings of safety," and "understanding own condition". Telenursing with home monitoring indicated a trend to accurately detect early-stage changes. Participant acceptance was acceptable. It would be feasible to conduct a randomized, controlled trial using this model with some modifications.

COPD transitions in health and self-management: service users' experiences from everyday life

Purpose

To explore how persons living with COPD experience transitions related to health, self-management, and follow-up from the healthcare services.

Patients and methods

This study is part of a participatory research project. Six males and five females living with COPD, with a COPD assessment test score of 21–29, participated; all the participants were living at home. Data were collected in qualitative research interviews and analyzed using qualitative content analysis highlighting the participants’ experiences.

Results

The findings showed two main themes: “The struggle to keep going” and “The need for continuity and competent facilitation”. The participants reported complex health transitions, with changes in roles and function, demanding exacerbations and critical events, and challenges with learning needed self-management. They expressed a great need for and had great benefit from, education, rehabilitation, and follow-up in their management of everyday life. Not all received offers in line with current guidelines.

Conclusion

In-depth knowledge of patients’ experienced COPD transitions offers clinicians guidance for the timing and quality of follow-up services. Life with COPD entails challenging transitions in health and self-management. Good rehabilitation and follow-up from the healthcare services are needed throughout the disease trajectory. Participation in self-management education and rehabilitation that include psychosocial aspects may facilitate health-enhancing transitions and improve self-management skills. Experienced lack of competence and flexibility among healthcare providers hinders trust and collaboration. Access to stable and competent follow-up in the primary health services may facilitate cohesive services and collaborative self-management.

Downhill walking influence on physical condition and quality of life in patients with COPD: A randomized controlled trial

Background: Chronic Obstructive Pulmonary Disease (COPD), in addition to its respiratory problems, is accompanied by several musculoskeletal consequences. The aim of this study is to investigate the effectiveness of eccentric exercise in the form of downhill walking (DW) on respiratory capacity, physical function and quality of life (QOL) in patients with COPD. Methods: The randomized controlled trial was carried out during 2014 - 2015 in Hazrat-e-Rasool Hospital in Tehran, Iran. The study design was as an assessor blind RCT on 32 patients with COPD that randomly assigned to the eccentric training (ET) and control (CON) groups. Patients in ET group received a 12-week DW exercise on the treadmill while the patients in the control group were only treated by COPD conventional medications and walked on paved surfaces. Functional tests, FEV1, FEV1 to FVC and St. George's Respiratory Questionnaire (SGRQ) were used to assess the subject's physical status and QOL pre and post-intervention. Results: The FEV1 (p=0.008), FEV1/FVC (p=0.002), six-minute walk test (p=0.029), timed up & go test (p=0.023), SGRQ symptom (p=0.022), SGRQ activity (p=0.007), SGRQ impact (p=0.033) and total score of SGRQ (p=0.013) improved significantly in the ET group compare to the CON group. Conclusion: DW could have positive influence on physical status and QOL of patients with COPD.

Effect of the economic crisis on the use of health and home care services among Spanish COPD patients

Background

Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014.

Methods

We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles.

Results

We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p<0.001). No changes were found for hospitalizations, GP visits, and home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58-0.89).

Conclusion

We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of small magnitude.

Chronic Obstructive Pulmonary Disease Phenotypes: Implications for Care

Chronic obstructive pulmonary disease (COPD) phenotyping can help define clusters of patients with common characteristics that relate to clinically meaningful outcomes. In this review, we describe 7 clinically meaningful COPD phenotypes that can be identified by primary care physicians as well as specialists and that have specific management and prognostic implications: (1) asthma-COPD overlap phenotype, (2) frequent exacerbator phenotype, (3) upper lobe-predominant emphysema phenotype, (4) rapid decliner phenotype, (5) comorbid COPD phenotype, (6) physical frailty phenotype, and (7) emotional frailty phenotype.

Caregiver profiles in dementia related to quality of life, depression and perseverance time in the European Actifcare study: the importance of social health

OBJECTIVES

To identify caregiver profiles of persons with mild to moderate dementia and to investigate differences between identified caregiver profiles, using baseline data of the international prospective cohort study Actifcare.

METHODS

A latent class analysis was used to discover different caregiver profiles based on disease related characteristics of 453 persons with dementia and their 453 informal caregivers. These profiles were compared with regard to quality of life (CarerQoL score), depressive symptoms (HADS-D score) and perseverance time.

RESULTS

A 5-class model was identified, with the best Bayesian Information Criterion value, significant likelihood ratio test (p < 0.001), high entropy score (0.88) and substantive interpretability. The classes could be differentiated on two axes: (i) caregivers' age, relationship with persons with dementia, severity of dementia, and (ii) tendency towards stress and difficulty adapting to stress. Classes showed significant differences with all dependent variables, and were labelled 'older low strain', 'older intermediate strain', 'older high strain', 'younger low strain' and 'younger high strain'.

CONCLUSION

Differences exist between types of caregivers that explain variability in quality of life, depressive symptoms and perseverance time. Our findings may give direction for tailored interventions for caregivers of persons with dementia, which may improve social health and reduce health care costs.

Definition of a COPD self-management intervention: International Expert Group consensus

There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease (COPD) self-management intervention. We aimed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting.

In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement (1=totally disagree; 5=totally agree). The information provided was used to modify the definition for the next consensus round. Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores.

In total, 28 experts participated. The consensus round response rate varied randomly over the five rounds (ranging from 48% (n=13) to 85% (n=23)), and mean definition agreement scores increased from 3.8 (round 1) to 4.8 (round 5) with an increasing percentage of experts allocating the highest score of 5 (round 1: 14% (n=3); round 5: 83% (n=19)).

In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention, clarifying the requisites for such an intervention. Operationalisation of this conceptual definition in the near future will be an essential next step.