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Teugels A, van den Eijnden I, Keersmaekers B, Verstockt B, Sabino J, Vermeire S, Guadagnoli L, Van Diest I, Ferrante M. Disease Acceptance, but not Perceived Control, is Uniquely Associated with Inflammatory Bowel Disease-related Disability. J Crohns Colitis 2024; 18:1025-1033. [PMID: 38446059 DOI: 10.1093/ecco-jcc/jjae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND AIMS Disability, an important aspect of disease burden in patients with inflammatory bowel disease [IBD], has been suggested as a valuable clinical endpoint. We aimed to investigate how disease acceptance and perceived control, two psychological predictors of subjective health, are associated with IBD-related disability. METHODS In this cross-sectional study, adult IBD patients from the University Hospitals Leuven received a survey with questions about clinical and demographic characteristics, disease acceptance and perceived control [Subjective Health Experience model questionnaire], and IBD-related disability [IBD Disk]. Multiple linear regressions assessed predictors of IBD-related disability in the total sample and in the subgroups of patients in clinical remission or with active disease. RESULTS In the total sample (N = 1250, 54.2% female, median [interquartile range: IQR] age 51 [39-61] years, 61.3% Crohn's disease, 34.9% active disease), adding the psychological predictors to the model resulted in an increased explained variance in IBD-related disability of 19% compared with a model with only demographic and clinical characteristics [R2adj 38% vs 19%, p <0.001]. The increase in explained variance was higher for patients in clinical remission [ΔR2adj 20%, p <0.001] compared with patients with active disease [ΔR2adj 10%, p <0.001]. Of these predictors, disease acceptance was most strongly associated with disability in the total sample [β = -0.44, p <0.001], as well as in both subgroups [β = -0.47, p <0.001 and β = -0.31, p <0.001 respectively]. Perceived control was not significantly associated with disability when accounting for all other predictors. CONCLUSIONS Disease acceptance is strongly associated with IBD-related disability, supporting further research into disease acceptance as a treatment target.
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Affiliation(s)
- Anouk Teugels
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | | | - Bep Keersmaekers
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Livia Guadagnoli
- Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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Stambler DM, Feddema E, Riggins O, Campeau K, Breuch LAK, Kessler MM, Misono S. REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study. JMIR Hum Factors 2022; 9:e26461. [PMID: 35333191 PMCID: PMC8994149 DOI: 10.2196/26461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/10/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. OBJECTIVE We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. METHODS We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. RESULTS Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. CONCLUSIONS The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated.
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Affiliation(s)
| | - Erin Feddema
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
| | - Olivia Riggins
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | - Kari Campeau
- Department of English, University of Colorado-Denver, Denver, CO, United States
| | | | - Molly M Kessler
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | - Stephanie Misono
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
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Nguyen-Feng VN, Frazier PA, Roy N, Cohen S, Misono S. Perceived Control, Voice Handicap, and Barriers to Voice Therapy. J Voice 2021; 35:326.e13-326.e19. [PMID: 31604609 PMCID: PMC7138698 DOI: 10.1016/j.jvoice.2019.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.
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Affiliation(s)
| | - Patricia A Frazier
- Department of Psychology, College of Liberal Arts, University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Stephanie Misono
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
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Abstract
BACKGROUND Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF. OBJECTIVE The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status. METHODS A total of 115 patients with HF were included. Data on symptom status (Memorial Symptom Assessment Scale-HF), perceived control (Control Attitudes Scale-Revised), and self-care (Self-Care of Heart Failure Index) were collected. Other covariates included were age, gender, New York Heart Association class, comorbidity burden, and depressive symptoms. Multiple regression analyses were performed to analyze the data. RESULTS Lower perceived control predicted worse symptom status after controlling for covariates (P = .009). Other covariates predictive of worse symptom status were younger age, New York Heart Association class III/IV, and higher levels of depressive symptoms. Higher levels of perceived control were associated with better self-care (P = .044). Better self-care was associated with better symptom status (P = .038). CONCLUSIONS Lower levels of perceived control were independently associated with worse symptom status in patients with HF. Intervention strategies targeting perceived control should be tested to determine whether they could improve symptom status.
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Silva M, Roufosse F. Oral Corticosteroid Use for the Treatment of Chronic Eosinophilic Disease: A Patient's and His Physician's Experience. Adv Ther 2019; 36:2558-2566. [PMID: 31473972 PMCID: PMC6822817 DOI: 10.1007/s12325-019-01070-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Indexed: 11/24/2022]
Abstract
This article, coauthored by a patient with eosinophilic granulomatosis with polyangiitis (EGPA) initially presenting as severe eosinophilic asthma and his physician-specialist, discusses the use and management of oral corticosteroid (OCS) treatment. It also considers the importance of early diagnosis of a rare disease and patient education. The patient describes his journey from progressive worsening of asthma and eventual diagnosis of EGPA to long-term OCS treatment and then participation in a clinical trial for this rare disease, involving the introduction of targeted biologic therapy with OCS tapering. The physician describes the importance of patient referral to obtain a correct diagnosis and optimal maintenance treatment, the balance between risk of adverse events associated with long-term OCS use and benefits of disease control, and various aspects of patient participation in clinical trials. Finally, the patient describes the role of continual patient education in the management of disease and OCS treatment. These considerations can apply to all chronic inflammatory diseases requiring maintenance OCS treatment. Funding: AstraZeneca.
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Hammash M, McEvedy SM, Wright J, Cameron J, Miller J, Ski CF, Thompson DR, Biddle MJ, Wimsatt A, Schrader M, Smith RV, Chung ML, Moser DK. Perceived control and quality of life among recipients of implantable cardioverter defibrillator. Aust Crit Care 2019; 32:383-390. [DOI: 10.1016/j.aucc.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/28/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
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Liljeroos M, Strömberg A, Årestedt K, Chung ML. Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners. Eur J Cardiovasc Nurs 2018; 17:527-534. [PMID: 29381082 DOI: 10.1177/1474515118755721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. AIM The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. METHODS In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. RESULTS We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. CONCLUSION Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.
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Affiliation(s)
- Maria Liljeroos
- 1 Division of Nursing Sciences, Linköping University, Sweden.,2 Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- 1 Division of Nursing Sciences, Linköping University, Sweden.,3 Department of Cardiology, Linköping University, Sweden
| | - Kristofer Årestedt
- 1 Division of Nursing Sciences, Linköping University, Sweden.,4 Faculty of Health and Life Sciences, Linnaeus University, Sweden.,5 Kalmar County Council, Sweden
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Health-related quality of life in asthma patients - A comparison of two cohorts from 2005 and 2015. Respir Med 2017; 132:154-160. [PMID: 29229090 DOI: 10.1016/j.rmed.2017.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/13/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim was to investigate temporal variation in Health-Related Quality of Life (HRQL) and factors influencing low HRQL, in patients with asthma. MATERIAL AND METHODS Questionnaire data on patient characteristics and the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) scores from two separate cohorts of randomly selected Swedish primary and secondary care asthma patients, in 2005 (n = 1034) and 2015 (n = 1126). Student's t-test and analysis of covariance with adjustment for confounders compared mini-AQLQ total and domain scores in 2005 and 2015. Multivariable linear regression analyzed associations with mini-AQLQ scores. RESULTS The mean Mini-AQLQ scores were unchanged between 2005 and 2015 (adjusted means (95% CI) 2005: 5.39 (5.27-5.33) and in 2015: 5.44 (95% CI 5.32 to 5.38), p = 0.26). Overweight (regression coefficient 95% CI) (0.21 (-0.36 to -0.07)), obesity (-0.34 (-0,50 to -0.18)), one or more exacerbations during the previous six months (-0.64 (-0.79 to -0.50)), self-rated moderate/severe disease (-1.02 (-1.15 to -0.89)), heart disease (-0.42 (-0.68 to -0.16)), anxiety/depression (-0.31 (-0.48 to -0.13)) and rhinitis (-0.25 (-0.42 to -0.08)) were associated with lower HRQL. Higher educational level (0.32 (0.19-0.46)) and self-reported knowledge of self-management of exacerbations (0.35 (0.19-0.51)) were associated with higher HRQL. CONCLUSIONS HRQL in Swedish patients with asthma is generally good and unchanged during the last decade. Overweight, obesity, exacerbations, self-rated moderate/severe disease, heart disease, depression/anxiety and rhinitis were associated with lower HRQL, and high educational level and knowledge on self-management with higher HRQL.
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Predictors of perceived asthma control among patients managed in primary care clinics. Qual Life Res 2014; 24:55-65. [PMID: 24806353 DOI: 10.1007/s11136-014-0700-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To estimate the extent to which symptom status, physical activity, beliefs about medications, self-efficacy, emotional status, and healthcare utilization predict perceived asthma control over a period of 16 months among a primary care population. METHODS The current study is a secondary analysis of data from a longitudinal study that examined health outcomes of asthma among participants recruited from primary care clinics. Path analysis, based on the Wilson and Cleary and International Classification of Functioning, Disability and Health frameworks, was used to estimate the predictors of perceived asthma control. RESULTS The path analysis identified initial perceived asthma control asthma (β = 0.43, p < 0.0001), symptoms (β = 0.35, p < 0.0001), physical activity (β = 0.27, p < 0.0001), and self-efficacy (β = 0.29, p < 0.0001) as significant predictors of perceived asthma control (total effects, i.e., direct and indirect), while emotional status (β = 0.08, p = 0.03) was a significant indirect predictor through physical activity. The model explained 24 % of the variance of perceived asthma control. Overall, the model fits the data well (χ (2) = 6.65, df = 6, p value = 0.35, root-mean-square error of approximation = 0.02, Comparative Fit Index = 0.999, and weighted root-mean-square residual = 0.27). CONCLUSION Initial perceived asthma control, current symptoms status, physical activity, and self-efficacy can be used to identify individuals likely to have good perceived asthma control in the future. Emotional status also has an impact on perceived asthma control mediated through physical activity and should be considered when planning patient management. Identifying these predictors is important to help the care team tailor interventions that will allow individuals to optimally manage their asthma, to prevent exacerbations, to prevent other respiratory-related chronic disease, and to maximize quality of life.
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Vennera MDC, Picado C, Herráez L, Galera J, Casafont J. Factors associated with severe uncontrolled asthma and the perception of control by physicians and patients. Arch Bronconeumol 2014; 50:384-91. [PMID: 24773754 DOI: 10.1016/j.arbres.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/05/2014] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control. METHODS Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control. RESULTS According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only). CONCLUSIONS Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.
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Affiliation(s)
- María del Carmen Vennera
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
| | - César Picado
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - Lys Herráez
- Novartis Farmacéutica S.A., Barcelona, España
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Årestedt K, Ågren S, Flemme I, Moser DK, Strömberg A. A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners. Eur J Cardiovasc Nurs 2014; 14:317-25. [PMID: 24671774 DOI: 10.1177/1474515114529685] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed. OBJECTIVE The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners. METHODS A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach's alpha were used to validate the CAS. RESULTS The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74-0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex. CONCLUSIONS The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred.
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Affiliation(s)
- Kristofer Årestedt
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden Faculty of Health and Life Sciences, School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden Palliative Research Centre, Ersta Sköndal University Collage and Ersta Hospital, Stockholm, Sweden
| | - Susanna Ågren
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Inger Flemme
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping, Sweden
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Powell H, McCaffery K, Murphy VE, Hensley MJ, Clifton VL, Giles W, Gibson PG. Psychosocial variables are related to future exacerbation risk and perinatal outcomes in pregnant women with asthma. J Asthma 2013; 50:383-9. [PMID: 23368420 DOI: 10.3109/02770903.2012.757777] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the relationship between psychosocial variables, future exacerbation risk during pregnancy, and perinatal outcomes. METHODS A secondary analysis of a randomized controlled trial of exhaled nitric oxide versus guideline-based treatment adjustment in pregnant women with asthma. Women were recruited between 12 and 20 weeks gestation and monitored for the remainder of the pregnancy. Psychosocial questionnaires including the Perceived Control of Asthma Questionnaire, the Brief Illness Perception Questionnaire, and the Six-Item Short-Form State Trait Anxiety Inventory were assessed at randomization. Exacerbations were defined as hospitalization, emergency visit, unscheduled doctor visit, or oral corticosteroid use for worsening asthma. Perinatal outcomes included preterm birth, small for gestational age, and cesarean section. Multiple logistic regressions were performed with predictor variables, including demographics and psychosocial and clinical variables. RESULTS The 175 participants had a mean (SD) age = 28.5(5.4) years, forced expiratory volume in 1 second (FEV(1)%) predicted = 95.9(13.4), and asthma control score = 0.88(0.70). Greater perceived control of asthma reduced the odds of subsequent exacerbation (odds ratio (OR) [95%CI] 0.92 [0.85, 0.98], p = .016), cesarean without labor (0.84 [0.75, 0.94], p = .003), and preterm birth (0.84 [0.72, 0.97], p = .019), while increased anxiety increased the odds of subsequent exacerbation (1.05 [1.01, 1.08], p = .008). CONCLUSION Women's perceptions of asthma control and their psychosocial state (anxiety) are related to future exacerbation risk, cesarean section, and preterm birth.
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Affiliation(s)
- Heather Powell
- Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Lv Y, Zhao H, Liang Z, Dong H, Liu L, Zhang D, Cai S. A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Telemed J E Health 2012; 18:420-6. [PMID: 22667695 DOI: 10.1089/tmj.2011.0218] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Mobile phone short message service (SMS) has been suggested as a potentially powerful tool to improve asthma outcomes, and it can overcome external barriers such as time and distance to participate education programs. We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma (PCA). SUBJECTS AND METHODS One hundred fifty outpatients with asthma were randomly assigned to the control, traditional, and SMS groups. Patients in all groups received verbal education based on the Global Initiative for Asthma, and patients in the traditional group received additional individualized asthma action plan for self-management with peak expiratory flow monitoring and recording asthma diary, while patients in the SMS group received additional daily SMS reminders on their mobile phone. The six-item PCA Questionnaire (PCAQ-6), Standard Asthma-Specific Quality of Life [AQLQ(S)], spirometry, blood and induced sputum cell count, follow-up compliance rate, medicine compliance rate, and emergency department (ED) visits data were collected at the initial visit and at 12 weeks. RESULTS In total, 71 participants completed the trial for analysis. Patients' PCAQ-6 score was significantly increased in the SMS and traditional groups (p<0.001) after 12 weeks, and the change of patients' PCAQ-6 score in the SMS group was higher than in the traditional group (p=0.018). Patients in the SMS group had the highest AQLQ(S) score and follow-up rate after 12 weeks. The change in PCAQ-6 score was associated with change in AQLQ(S) score (r=0.442). Patients in all groups had better forced expiratory volume in 1 s (FEV1%) and fewer ED visits after 12 weeks, but no significant differences were found among the three groups in the changes of FEV1% and blood and induced sputum eosinophil counts and neutrophil counts. CONCLUSIONS SMS can improve PCA, and it has a greater advantage in improving follow-up rate and asthma-specific quality of life than traditional programs.
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Affiliation(s)
- Yanhua Lv
- Department of Respiration, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Dostaler SM, Olajos-Clow JG, Sands TW, Licskai CJ, Minard JP, Lougheed MD. Comparison of asthma control criteria: importance of spirometry. J Asthma 2012; 48:1069-75. [PMID: 22091743 DOI: 10.3109/02770903.2011.631243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To compare the measurements of asthma control using Canadian Thoracic Society (CTS) Asthma Management Consensus Summary and Global Initiative for Asthma (GINA) guidelines composite indices with and without spirometry. METHODS Asthma control parameters were extracted from electronic medical records (EMRs) of patients ≥6 years old at two primary care sites. Asthma control ratings calculated according to CTS and GINA criteria were compared. RESULTS Data were available from 113 visits by 93 patients, aged 6-85 years (38.7 ± 24.8; mean ± SD). The proportion of visits at which individuals' asthma was completely controlled was 22.1% for CTS symptoms only and 9.7% for CTS with spirometry (p < .01); and 17.7% versus 14.1% for GINA symptoms only versus symptoms with spirometry (p = .125). CONCLUSIONS Asthma control ratings using GINA and CTS criteria are discordant in more than half of the patients deemed "in control" by at least one scale. Differences in the spirometry criterion threshold are primarily responsible for this discordance. Failure to include spirometry as part of the control index consistently overestimates asthma control and may underestimate future risk of exacerbations.
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Powell H, McCaffery K, Murphy VE, Hensley MJ, Clifton VL, Giles W, Gibson PG. Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma. J Asthma 2012; 48:1032-40. [PMID: 22091740 DOI: 10.3109/02770903.2011.631239] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the psychosocial impact and perceived teratogenic (fetal harm due to medication) risks of asthma treatment (inhaled/oral corticosteroids and β-agonist) during pregnancy. AIMS To assess the perception of asthma control, quality of life (QoL), and perceived risks of therapy in pregnant women with asthma. METHODS Pregnant women with asthma (n = 125) were recruited between 12 and 20 weeks gestation. QoL (generic: Short Form-12 Health Survey v1, and asthma specific: Asthma Quality of Life Questionnaire-Marks (AQLQ-M)) and psychological variables were assessed using the Perceived Control of Asthma Questionnaire (PCAQ), the Brief Illness Perception Questionnaire, and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Women's perceptions of the teratogenic risks of asthma therapy were also assessed and analyzed for adherence to maintenance inhaled corticosteroids (ICSs), poor asthma control, and QoL. RESULTS Women reported good QoL (median AQLQ-M total score/maximum score = 0.88/10), moderate ability to deal with asthma symptoms (mean PCAQ score = 42.6/55), positive beliefs about their asthma and low anxiety (median STAI score = 26.7/80). Perceived teratogenic risks for asthma drugs were excessive and class dependent. Women perceived there was a 42% teratogenic risk for oral corticosteroid, a 12% risk for ICSs, and a 5% risk with short-acting β-agonist. Illness beliefs, emotional response to illness (p = .030), age ≥ 30 years (p = .046), and maintenance ICS use (p = .045) were significantly associated with uncontrolled asthma, while maintenance ICS use (p = .023), illness beliefs, consequences (p = .044), timeline (p = .016), and emotional response (p = .015) and anxiety (p ≤ .0001) were significantly associated with reduced QoL. CONCLUSIONS In pregnancy, women with asthma experience good QoL but overestimate teratogenic risks of asthma medication. Maintenance ICS use, illness beliefs, and anxiety are associated with impaired QoL and asthma control.
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Affiliation(s)
- Heather Powell
- Department of Respiratory & Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
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Flemme I, Johansson I, Strömberg A. Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients. J Clin Nurs 2011; 21:311-21. [DOI: 10.1111/j.1365-2702.2011.03847.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Janssens T, Verleden G, De Peuter S, Petersen S, Van den Bergh O. The influence of fear of symptoms and perceived control on asthma symptom perception. J Psychosom Res 2011; 71:154-9. [PMID: 21843750 DOI: 10.1016/j.jpsychores.2011.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/06/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-reported asthma symptoms correlate only modestly with measures of underlying pathophysiological mechanisms. In this study, we investigated the role of fear of symptoms and perceived control on respiratory symptom perception in patients with asthma. METHODS Patients with intermittent to moderate persistent asthma (N=32) were administered 4 subsequent rebreathing challenges (one using 100% O(2) and three using 5% CO(2) and 95% O(2)). We manipulated perceived control by providing information on the availability/unavailability of rescue medication during the challenges (perceived control/no control condition). Perceived symptoms and lung function were assessed after each rebreathing challenge. RESULTS Persons with low fear of symptoms reported respiratory symptoms to be less unpleasant during the perceived control condition compared to the no control condition. The reverse was found for persons with high fear of symptoms. The interaction between fear of symptoms and the control manipulations was mediated by threat perception. CONCLUSION Messages intended to increase perceived control over symptoms may actually increase threat in persons with high fear of symptoms and eventually increase unpleasantness of respiratory sensations. This finding underlines the importance of affective processes in the perception of asthma symptoms and shows that instructions to patients should take pre-existing fear levels into account.
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Affiliation(s)
- Thomas Janssens
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Belgium
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Katz PP, Morris A, Julian L, Omachi T, Yelin EH, Eisner MD, Blanc PD. Onset of depressive symptoms among adults with asthma: results from a longitudinal observational cohort. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 19:223-30. [PMID: 20169291 DOI: 10.4104/pcrj.2010.00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Individuals with asthma may be at increased risk of depression, but few studies have identified precursors to the onset of depression. The study goal was to identify risk factors for depression onset among a community-based sample of adults with asthma. METHODS Data were obtained from three telephone interviews conducted at 2-yearly intervals on a longitudinal cohort of adults with asthma (n=439). The Center for Epidemiologic Studies Depression scale (CESD) was used to measure depressive symptoms. Multiple regression analyses tested associations of sociodemographic and health-related variables with depression prevalence (cross-sectional analyses) and incident depression (longitudinal analyses). RESULTS 15% of subjects were classified as "depressed" (CESD> or =23) at each interview. Individuals depressed at baseline were more likely to drop out (OR=1.76 [95% CI 1.05, 2.96]). Low perceived control of asthma (measured with the Perceived Control of Asthma Questionnaire [PCAQ]) exhibited the most consistent association with depression. Lower PCAQ was cross-sectionally associated with depression (OR=0.51 per 0.5 SD difference in PCAQ [0.35, 0.75]). Onset of depression was noted in 38 individuals. Decrease in perceived control at follow-up was associated with depression onset (OR=7.47 [2.15, 26.01]). CONCLUSIONS Low perceived control of asthma predicted depression onset among adults with asthma. This risk factor may respond to self-management education.
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Affiliation(s)
- Patricia P Katz
- Department of Medicine, University of California, San Francisco, California 94143-0936, USA.
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Asthma education delivered in an emergency department and an asthma education center: a feasibility study. Adv Emerg Nurs J 2010; 31:73-85. [PMID: 20118856 DOI: 10.1097/tme.0b013e31818bf23d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Implementation of asthma education in the emergency department (ED) setting is controversial. Time constraints and patient anxiety may be potential barriers to learning. This study aimed to describe the feasibility and impact of a brief evidence-based asthma education intervention delivered in the ED and an asthma education center (AEC) on asthma knowledge and perceived control. The educational intervention was easily integrated into routine care in the ED. Participants were similar except for age and current state of anxiety. At follow-up, both groups showed a significant increase in asthma knowledge (ED, n = 3.1, SD = 2.1, p < .01; AEC, n = 2.6, SD = 2.7, p = .01). Perceived control improved significantly in the ED (n = 2.6, SD = 3.9; p = .01). Despite higher state anxiety scores in the ED setting, a brief asthma educational intervention resulted in a short-term increase in asthma knowledge and perceived control. Asthma knowledge also increased after the intervention in the AEC setting. Educational initiatives are feasible and may be beneficial in an ED, providing an additional opportunity for counseling that should not be missed.
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Eddington AR, Mullins LL, Fedele DA, Ryan JL, Junghans AN. Dating relationships in college students with childhood-onset asthma. J Asthma 2010; 47:14-20. [PMID: 20100015 DOI: 10.3109/02770900903427003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The current study investigated whether differences existed in dating anxiety and fear of intimacy between individuals with childhood-onset asthma and individuals without a chronic illness. Analyses were also conducted to determine if dating anxiety or fear of intimacy were predictors of health-related quality of life in individuals with asthma and healthy controls. Additionally, potential gender differences in dating anxiety and fear of intimacy in individuals with childhood-onset asthma were explored. METHODS College undergraduates at least 17 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Dating Anxiety Scale for Adolescents, the Fear of Intimacy Scale, and the SF-36 Health Survey, a measure of health-related quality of life. RESULTS There were no significant differences between self-identified participants with asthma and matched healthy controls on the Dating Anxiety Scale or Fear of Intimacy Scale. However, dating anxiety was a significant predictor of mental health-related quality of life in participants with asthma but not in matched health controls. Fear of intimacy was not a significant predictor of mental or physical health-related quality of life in individuals with asthma. In addition, women with asthma endorsed significantly more dating anxiety and lower physical health-related quality of life than males with asthma. CONCLUSION College students with asthma appear to experience similar levels of dating anxiety and fear of intimacy than healthy college students; however, their anxiety about dating may have a larger effect on health-related quality of life than healthy individuals. Additional examination of dating and interpersonal relationships among individuals with asthma appears warranted, particularly as it concerns possible gender differences in individuals with childhood-onset asthma.
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Affiliation(s)
- Angelica R Eddington
- Department of Clinical Psychology, Oklahoma State University, Stillwater, Oklahoma 74075, USA.
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Fedele DA, Mullins LL, Eddington AR, Ryan JL, Junghans AN, Hullmann SE. Health-related Quality of Life in College Students with and without Childhood-Onset Asthma. J Asthma 2009. [DOI: 10.1080/02770900903184229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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The Control Attitudes Scale-Revised: psychometric evaluation in three groups of patients with cardiac illness. Nurs Res 2009; 58:42-51. [PMID: 19092554 DOI: 10.1097/nnr.0b013e3181900ca0] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perceived control is a construct with important theoretical and clinical implications for healthcare providers, yet practical application of the construct in research and clinical practice awaits development of an easily administered instrument to measure perceived control with evidence of reliability and validity. OBJECTIVE To test the psychometric properties of the Control Attitudes Scale-Revised (CAS-R) using a sample of 3,396 individuals with coronary heart disease, 513 patients with acute myocardial infarction, and 146 patients with heart failure. METHODS Analyses were done separately in each patient group. Reliability was assessed using Cronbach's alpha to determine internal consistency, and item homogeneity was assessed using item-total and interitem correlations. Validity was examined using principal component analysis and testing hypotheses about known associations. RESULTS Cronbach's alpha values for the CAS-R in patients with coronary heart disease, acute myocardial infarction, and heart failure were all greater than .70. Item-total and interitem correlation coefficients for all items were acceptable in the groups. In factor analyses, the same single factor was extracted in all groups, and all items were loaded moderately or strongly to the factor in each group. As hypothesized in the final construct validity test, in all groups, patients with higher levels of perceived control had less depression and less anxiety compared with those of patients who had lower levels of perceived control. CONCLUSION This study provides evidence of the reliability and validity of the 8-item CAS-R as a measure of perceived control in patients with cardiac illness and provides important insight into a key patient construct.
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Muraki M, Ichihashi H, Haraguchi R, Iwanaga T, Kubo H, Tohda Y. Comparison of the Asthma Health Questionnaire-33-Japan and the short-form 36-item health survey for measuring quality of life in Japanese patients with asthma. Allergol Int 2008; 57:339-46. [PMID: 18690008 DOI: 10.2332/allergolint.o-07-516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 04/24/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Asthma Health Questionnaire (AHQ)-Japan is useful for assessing quality of life (QOL) in Japanese patients with asthma. However, no studies have compared the AHQ-Japan to other QOL instruments. METHODS The AHQ-33-Japan and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) were completed simultaneously by 126 Japanese patients with asthma (48 men, 78 women; 58.1 +/- 17.3 years of age), and the data were compared. RESULTS Poor negative correlations (correlation coefficient (r) = -0.20 to -0.44, P < 0.05) were observed for 38 combinations of the subscales of these QOL instruments. As the severity of the patients' asthma increased, the scores of most subscales of both QOL instruments became worse. However, the AHQ-33 was more sensitive for severity than the SF-36. On logistic regression analysis, high Asthmatic Symptoms, Factors which Worsened Symptoms, Emotion, Daily Activity, and Social Activity subscale scores, as well as a high total 32-item score, of the AHQ-33 were associated with an increased risk of moderate to severe asthma. On the other hand, only the Physical functioning subscale score of the SF-36 was associated with an increased risk of moderate to severe asthma. CONCLUSIONS Our results show that the AHQ-33 is useful as a disease-specific QOL instrument in Japanese patients with asthma and that it is better than the SF-36, which is a generic QOL instrument. In the future, the AHQ-33 should be compared to other asthma-specific questionnaires.
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Affiliation(s)
- Masato Muraki
- Department of Respiratory Medicine and Allergology, Kinki University School of Medicine, Osaka, Japan.
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Braido F, Baiardini I, Balestracci S, Fassio O, Ravera S, Bellotti M, Canonica GW. The relationship between asthma control and quality-of-life impairment due to chronic cough: a real-life study. Ann Allergy Asthma Immunol 2008; 101:370-4. [PMID: 18939724 DOI: 10.1016/s1081-1206(10)60312-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of asthma therapy is to achieve optimal disease control and quality-of-life (QoL) improvements. Good correlation is reported between a composite evaluation of asthma control (the Asthma Control Test [ACT]) and QoL, with emphasis on asthma as a frequent cause of chronic cough and worsening of QoL due to chronic cough. OBJECTIVES To investigate asthma control in real life and to evaluate chronic cough-related impairment of QoL in patients with different degrees of asthma control evaluated by the ACT. METHODS Outpatients awaiting physician visits for asthma evaluation were asked to complete the ACT, the Chronic Cough Impact Questionnaire (CCIQ), and a rhinitis symptom score (Total Symptom Score [TSS] 5). RESULTS A total of 122 patients (mean [SD] age, 44 [15] years; age range, 15-75 years; 61.5% female) were enrolled in the study, of whom 74% reported rhinitis in conjunction with asthma. Overall asthma control was substantially less than optimal (ACT mean score, 14) in 44% of patients. Asthma control correlated to a limited degree with the CCIQ among the total sample. In patients with asthma alone, the correlation between the ACT and the CCIQ was much improved. In patients with comorbid rhinitis, only those with significant symptoms (as determined by the TSS5) reported using rhinitis treatment; among these, no significant correlation between the ACT and the CCIQ was found. CONCLUSIONS Asthma control in real life is less than optimal in substantially few patients. The importance of cough in asthma is highlighted by good correlation between cough and the ACT score in patients without comorbid rhinitis. In patients with comorbid rhinitis, cough appears related more to rhinitis than to asthma control. The combined use of the ACT and the CCIQ may be useful to improve asthma management, especially among patients in whom cough remains a prominent symptom.
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Affiliation(s)
- Fulvio Braido
- Allergy and Respiratory Diseases, DIMI, Genoa University, Genoa, Italy.
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Walker J, Winkelstein M, Land C, Lewis-Boyer L, Quartey R, Pham L, Butz A. Factors that influence quality of life in rural children with asthma and their parents. J Pediatr Health Care 2008; 22:343-50. [PMID: 18971080 PMCID: PMC2592842 DOI: 10.1016/j.pedhc.2007.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 07/23/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Among rural children with asthma and their parents, this study examined the relationship between parental and child reports of quality of life and described the relationship of several factors such as asthma severity, missed days of work, and asthma education on their quality of life. METHODS Two hundred one rural families with asthma were enrolled in a school-based educational program. Intervention parents and children participated in interactive asthma workshop(s) and received asthma devices and literature. Parent and child quality of life measurements were obtained before and after the intervention using Juniper's Paediatric Caregivers Quality of Life and Juniper's Paediatric Quality of Life Questionnaires. Asthma severity was measured using criteria from the National Asthma Education and Prevention Program guidelines. RESULTS There was no association between parent and child total quality of life scores, and mean parental total quality of life scores were higher at baseline and follow-up than those of the children. All the parents' quality of life scores were correlated with parental reports of missed days of work. For all children, emotional quality of life (EQOL) was significantly associated with parental reports of school days missed (P = .03) and marginally associated with parental reports of hospitalizations due to asthma (P = .08). Parent's EQOL and activity quality of life (AQOL) were significantly associated with children's asthma severity (EQOL, P = .009; AQOL, P = .03), but not the asthma educational intervention. None of the child quality of life measurements was associated with asthma severity. DISCUSSION Asthma interventions for rural families should help families focus on gaining and maintaining low asthma severity levels to enjoy an optimal quality of life. Health care providers should try to assess the child's quality of life at each asthma care visit independently of the parents.
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Affiliation(s)
- Jennifer Walker
- Johns Hopkins University, School of Medicine, 200 N Wolfe St, Baltimore, MD 21205, USA.
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Hyperventilation symptoms are linked to a lower perceived health in asthma patients. Ann Behav Med 2008; 35:97-104. [PMID: 18347909 DOI: 10.1007/s12160-007-9014-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Hyperventilation symptoms are among the sensations asthma patients tend to report during exacerbations of their disease. However, little is known about their importance for the patients' perceived well-being. METHOD We therefore studied the association of reported hyperventilation symptoms (Asthma Symptom Checklist) with perceived physical and mental health (36-item Short-form Health Survey) in a sample of primary care asthma patients (N = 190). We also studied the potential role of perceived control of asthma (Perceived Control of Asthma Questionnaire) in mediating any association between these variables. RESULTS In hierarchical multiple regression analyses controlling for demographics, asthma severity, and other asthma symptoms (obstruction, congestion, panic-fear, irritation, and fatigue), hyperventilation symptoms were significantly associated with both physical and mental health status. This association was partially mediated by perceived control of asthma. CONCLUSION It is possible that hypocapnia creates symptoms that asthma patients cannot control by using their antiasthmatic medication, thus compromising their perceived control over the management of their asthma, and consequently their perceived health. Behavioral interventions should address the problem of hyperventilation in asthma.
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Fanelli A, Cabral ALB, Neder JA, Martins MA, Carvalho CRF. Exercise training on disease control and quality of life in asthmatic children. Med Sci Sports Exerc 2007; 39:1474-80. [PMID: 17805077 DOI: 10.1249/mss.0b013e3180d099ad] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children. However, the actual impact of physical training on clinical indicators of disease control remains controversial. METHODS Thirty-eight children with moderate to severe persistent asthma were randomly assigned to control (N=17) and training (N=21) groups. Spirometry, exercise challenge, and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart. Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores were also recorded. RESULTS Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise (P<0.05); in contrast, no significant changes were found in controls. Severity of exercise-induced bronchoconstriction (EIB) and postexercise breathlessness were significantly lessened in trained patients; improvement in fitness and EIB, however, were not linearly related (P>0.05). In addition, PAQLQ scores improved only in trained children (P<0.01). Daily doses of inhaled steroids were reduced in trained patients (52%), but they remained unchanged or increased in controls (70.6%) (P=0.07). CONCLUSION Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children. These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease.
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Affiliation(s)
- Adriana Fanelli
- Physical Therapy Department, University City of Sao Paulo, and Hospital Darcy Vargas, Sao Paulo, Brazil
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Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K. Quality of life and measures of asthma control in primary health care. J Asthma 2007; 44:747-51. [PMID: 17994405 DOI: 10.1080/02770900701645298] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.
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Affiliation(s)
- Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
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Chang CH, Sharp LK, Kimmel LG, Grammer LC, Kee R, Shannon JJ. A 6-item brief measure for assessing perceived control of asthma in culturally diverse patients. Ann Allergy Asthma Immunol 2007; 99:130-5. [PMID: 17718100 DOI: 10.1016/s1081-1206(10)60636-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A concise yet accurate measurement tool is needed for use in research and practice in asthma self-management perceptions across culturally diverse patient populations. OBJECTIVES To evaluate the psychometric properties of the 11-item Perceived Control of Asthma Questionnaire (PCAQ) and to derive a brief, psychometrically sound, and culturally sensitive measure using item response theory. METHODS The PCAQ was administered as one of a battery of measures to 375 adults with asthma as part of an ongoing larger project studying asthma disparities. Analyses of differential item functioning (DIF) were conducted to detect the effects of sex, race/ethnicity, and health literacy on psychometric properties. RESULTS Forty-eight percent of the sample was non-Hispanic white and 44% was African American. The mean +/- SD age was 43.7 +/- 13.7 years. The derived 6-item version, with 5 DIF items not scored, correlated highly with its full version (r = 0.903; P < .001). CONCLUSIONS The 6-item PCAQ short form has the potential to maintain scale integrity while reducing administration time and lessening survey fatigue in studies using multiple questionnaires. DIF analyses also enabled us to understand the unique aspects of perceived asthma control in demographic groups most affected by asthma.
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Affiliation(s)
- Chih-Hung Chang
- Buehler Center on Aging and Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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McNairn JDK, Ramos C, Portnoy JM. Outcome measures for asthma disease management. Curr Opin Allergy Clin Immunol 2007; 7:231-5. [PMID: 17489040 DOI: 10.1097/aci.0b013e32814a5583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Many interventions have been undertaken in managing asthma in a population-based framework. The identification of successful interventions would guide policy implementation to improve outcomes in patient morbidity and mortality and healthcare costs. RECENT FINDINGS Several studies have focussed on emergency room interventions in asthma management. Many support the existence of the "teachable moment" to lead to interventions that are effective. Other popular interventions are community-based educational programmes, targeting clinician and patient behavior modification. In some cases, it is unclear how these interventions impact patient-specific outcomes such as quality of life, symptom-free days, or missed days of school or work as these were not measured. Most studies separate patients on the basis of age (adults versus children), adding yet another level of complexity to the development of useful interventions. SUMMARY Several of the interventions failed to show a significant improvement of patient-centered asthma outcomes when they were measured. This was despite an improvement in surrogate measures, such as attendance of follow-up appointments. Many studies did not (or were not designed to) show a durable response. Further research is needed to understand this chronic disease and devise effective interventions with appropriate outcomes for measuring their effectiveness.
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Affiliation(s)
- Julie D K McNairn
- Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA
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