The role of self-efficacy in assisting patients with chronic obstructive pulmonary disease to manage breathing difficulty

Association of physical and psychological health status between chronic obstructive pulmonary disease patients and their family caregivers

We performed this cross-sectional study with 72 chronic obstructive pulmonary disease (COPD) patients and their family caregivers to analyze relationship of physical and psychological health status between COPD patients and caregivers. Most caregivers were female (100%). Caregiver depression and burden were significantly associated with caregiving hours. In path analysis, the higher the patient's social support, the higher the patient's self-efficacy. The higher the patient's self-efficacy, the lower the care burden of the caregiver. Based on our results, there was a significant correlation of physical and psychological factors between patients and family caregivers.

Methodological Issues Encountered in a Study of Hospitalized COPD Patients

A study with hospitalized chronic obstructive pulmonary disease (COPD) patients determined the feasibility of providing and evaluating a tailored education program. This article describes two methodological issues encountered. Issues included recruitment and retention, and selection of outcome measures. The COPD Self-Efficacy Scale (CSES) and Dartmouth Functional Health Status (FHS) charts provided data on evaluation and outcome measurements. Of 67 patients, 55% met eligibility criteria, 73% (n = 27) agreed to participate, and 74% (n = 20) completed the study. Results revealed acceptance and satisfaction with the educational intervention. The median CSES score, significantly (z = 3.51,p = .004) improved from 53% to 82%. In FHS, a 20% improvement occurred in all except social support. Methodological concerns with the CSES reinforced the need for further investigation of the reliability and validity for hospitalized COPD patients. Researchers’ observations may assist in planning educational interventions and program evaluations with hospitalized COPD patients.

Home nursing care with the self-care model improves self-efficacy of patients with chronic obstructive pulmonary disease

AIM

This study was carried out as an intervention study to determine the effect of nursing care provided at home with the self-care model on the self-efficacy of patients with chronic obstructive pulmonary disease in northern Turkey.

METHODS

The study sample totaled 106 patients with chronic obstructive pulmonary disease divided into two groups. The intervention group and the control group each included 53 patients. To collect data, the patient data sheet, Orem's self-care model-based data collection form, symptom evaluation form, Medical Research Council dyspnea scale, and the chronic obstructive pulmonary disease self-efficacy scale (CSES) were used. The nursing care applied for the intervention group consisted of four visits, two during the first month and two for the next 2 months. An educational guidebook was distributed to the intervention group during the first visit, and at all visits, education, care, and supervision were provided according to the care plan. All data were analyzed with the number, percentage, χ(2) -test, Kruskal-Wallis H test, Wilcoxon rank sum test, and Mann-Whitney U-test.

RESULTS

The dyspnea level measured at the last visit for the control group was high compared with the intervention group (P < 0.05). The chronic obstructive pulmonary disease self-efficacy scale scores for subscale dimensions at the last visit and the general score for the intervention group were high compared with the first visit scores (P < 0.05).

CONCLUSION

According to the study results, home nursing care based on the Orem's self-care model is effective in improving self-efficacy of patients with chronic obstructive pulmonary disease.

Anxiety and depression following pulmonary rehabilitation

AIM

The aim of this study was to evaluate changes and predictive factors of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) before and up to 3 months after pulmonary rehabilitation (PR).

METHODS

A single group longitudinal design of patients with COPD underwent a PR programme. The measurements took place at baseline (T1: N=100), immediately before (T2: N=66), immediately after (T3: N=54) and 3 months after (T4: N=43) the programme. The programme was a 6-week outpatient programme, including education, psychosocial support and training sessions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, self-efficacy by the COPD self-efficacy scale, lung function by spirometry and exercise capacity by incremental shuttle walking test. Mixed effect model analyses were used.

RESULTS

Results showed a tendency of less anxiety and depression immediately after (T3) compared with immediately before (T2) the PR programme, but the changes were not significant. Results also showed that female reported significantly more anxiety than male (p=0.019), better exercise capacity predicted significantly less depression (p=0.049), and higher self-efficacy predicted both significantly less anxiety (p=0.001) and less depression (p=0.005).

CONCLUSIONS

A tendency of less anxiety and depression during the PR programme was found, but the changes were not significant. Higher level of self-efficacy and better exercise capacity are suggested to relieve anxiety and depression.

A Critical Review of Effects of COPD Self-Management Education on Self-Efficacy

Chronic obstructive pulmonary disease (COPD) causes progressive airflow limitation which results in prolonged episodes of coughing and shortness of breath. COPD self-management education (COPDSME) programs attempt to enhance patient self-efficacy for managing symptoms. The purpose of this paper was to conduct a critical literature review that identified peer-reviewed articles assessing the effects of COPDSME on self-efficacy outcomes. Seven articles were located after an exhaustive search. Most studies () reported statistically significant improvements in self-efficacy following intervention. Almost all of the studies tested interventions that drew upon at least 2 recommended sources of efficacy information. Two studies specifically noted increased self-efficacy for controlling physical exertion following COPDSME. Within the reviewed studies, the content within each educational treatment varied widely and showed a lack of standardization, and the types of instruments used to assess self-efficacy varied. This paper highlights the need for more controlled trials that investigate potential between-subjects effects of different types of COPDSME programs on self-efficacy outcomes. Incorporating practice models for patient-centered primary care in COPD requires the use of tailored efficacy building strategies for specific self-management behaviors.

Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease

AIMS

To describe self-management, symptom monitoring and the associated influences among older adults with chronic obstructive pulmonary disease.

BACKGROUND

Optimal self-management and monitoring of key symptoms in patients with chronic obstructive pulmonary disease reduces dyspnoea and preventable hospitalizations.

METHOD

A prospective, descriptive survey design was used and data collected from patients with moderate severity chronic obstructive pulmonary disease during home interviews between April 2005 and June 2006. Predictors of self-management and symptom monitoring were determined by linear regression analyses.

RESULTS

Patients' (n = 78) mean age was 73.37 years (SD 7.52); 55.1% were male and 66.7% were married. Most (92.3%) had concurrent illnesses, and 48.7% had been admitted to hospital for chronic obstructive pulmonary disease in the past 6 months. Self-management was good to very good, with poorer self-management predicted by lower self-efficacy (beta = -0.21), a weaker sense of coherence (beta = -0.03), and no hospitalization in the past 6 months (beta = -05). Symptom monitoring was not ideal, with more than 20% of patients not monitoring any of the key symptoms. More frequent symptom monitoring occurred among participants who were married (beta = 5.14) and had more severe disease (beta = 0.79).

CONCLUSION

As self-management and symptom monitoring ensure better outcomes among patients with chronic obstructive pulmonary disease, health professionals should encourage these behaviours. Involving partners, promoting self-efficacy and understanding of sense of coherence are helpful in this process.

Self-management education for patients with chronic obstructive pulmonary disease

BACKGROUND

There is great interest in chronic obstructive pulmonary disease (COPD) and the associated large burden of disease. COPD is characterised by frequent day by day fluctuations, and repetitive clinical exacerbations are typical. Self-management is a term applied to educational programmes aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. In COPD, the value of self-management education is not yet clear. The first Cochrane review about self-management was published in 2003. It was intended to shed light on the effectiveness of self-management programmes in COPD and the relative efficacy of their constitutive elements. No conclusions about the effectiveness of self-management could be drawn because of the large variation in outcome measures used in the limited number of included studies. This article describes the first update of this review.

OBJECTIVES

The objective of this review was to assess the settings, methods and efficacy of COPD self-management education programmes on health outcomes and use of health care services.

SEARCH STRATEGY

We searched the Cochrane Airways Group trial register, MEDLINE (January 1985 to January 2006), reference lists, and abstracts of medical conferences.

SELECTION CRITERIA

Controlled trials (randomised and non-randomised) of self-management education in patients with COPD. Studies focusing mainly on pulmonary rehabilitation and studies without usual care as a control group were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed study quality and extracted data. Investigators were contacted for additional information.

MAIN RESULTS

The reviewers included 15 group comparisons drawn from 14 trials. They assessed a broad-spectrum of interventions and health outcomes with different follow-up times. Meta-analyses could often not appropriately be performed because of heterogeneity among studies. The studies showed a significant reduction in the probability of at least one hospital admission among patients receiving self-management education compared to those receiving usual care (OR 0.64; 95% CI (0.47 to 0.89)). This translates into a one year NNT ranging from 10 (6 to 35) for patients with a 51% risk of exacerbation, to an NNT of 24 (16 to 80) for patients with a 13% risk of exacerbation. On the disease specific SGRQ, differences reached statistical significance at the 5% level on the total score (WMD -2.58; 95% CI (-5.14 to -0.02)) and impact domain (WMD -2.83; 95% CI (-5.65 to -0.02)), but these difference did not reach the clinically relevant improvement of 4 points. A small but significant reduction was detected in dyspnoea measured with the BORG-scale (WMD -0.53; 95% CI (-0.96 to -0.10)). No significant effects were found either in number of exacerbations, emergency department visits, lung function, exercise capacity, and days lost from work. Inconclusive results were observed in doctor and nurse visits, on symptoms other than dyspnoea, the use of courses of oral corticosteroids and antibiotics, and the use of rescue medication.

AUTHORS' CONCLUSIONS

It is likely that self-management education is associated with a reduction in hospital admissions with no indications for detrimental effects in other outcome parameters. This would in itself already be enough reason for recommending self-management education in COPD. However, because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programmes in COPD. There is an evident need for more large RCTs with a long-term follow-up, before more conclusions can be drawn.

Family support, perceived self-efficacy and self-care behaviour of Turkish patients with chronic obstructive pulmonary disease

AIM

The purpose of this study was to describe family support, self-efficacy perception and self-care behaviour among patients with chronic obstructive pulmonary disease and to ascertain the relationship between these variables.

BACKGROUND

It is important to work at improving confidence in the patients' ability to follow a self-care regimen by increasing self-efficacy. Family support also plays an important role in self-care activities.

METHOD AND DESIGN

The study design is descriptive and correlational. Of 230 patients with chronic obstructive pulmonary disease who were recruited for the study, 200 agreed to participate. The patients were recruited by the first author from an outpatient clinic in the Department of Chest Disease of a university hospital and a pulmonary hospital in Erzurum, eastern Turkey. Data were collected by using a demographic data form, the Perceived Social Support from Family Scale, the Chronic Obstructive Pulmonary Disease Self-efficacy Scale and the Alberto Chronic Obstructive Pulmonary Disease Self-care Behaviour Inventory.

RESULTS

Although most participants (91.5%) perceived that they had family support and more than three quarters (73.0%) of the participants engaged in an adequate amount of self-care behaviours, only twenty five participants' (12.5%) perceived self-efficacy as high. There were statistically significant positive relationships between family support and self-care behaviour (r=0.302; p=0.01) and between self-efficacy and self-care behaviour (r=0.186; p=0.01). There was also a statistically significant positive relationship between family support and self-efficacy (r=0.412; p=0.01).

CONCLUSION

The results of the study demonstrated weak to moderate, but statistically significant, relationships between family support and self-care behaviours, self-efficacy and self-care behaviour and family support and self-efficacy in Turkish patients with chronic obstructive pulmonary disease.

RELEVANCE TO CLINICAL PRACTICE

The assessment of the family support, self-efficacy and self-care behaviours of the patients with chronic obstructive pulmonary disease should be an essential part of nursing practice. The study also provides the foundation for the conduct of future studies of self-care training for managing patients with chronic obstructive pulmonary disease.

Effects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease

Self-management is crucial in people with chronic diseases, and self-efficacy has been shown to impact patients' self-management. The purposes of this study were to 1) determine the effect of intervention on self-efficacy and 2) determine the relationship between domain-specific self-efficacy, walking performance, and symptom severity in patients with chronic obstructive pulmonary disease (COPD). Subjects (n=102, forced expiratory volume in 1 second % predicted 44.8+/-14) received one of three self-management interventions. Self-efficacy for walking and managing shortness of breath, walking performance, and shortness of breath severity were measured at baseline and after intervention. Self-efficacy increased after intervention (P<0.01). Self-efficacy for walking was positively related to walking performance (P<0.05). Self-efficacy for managing shortness of breath was positively related to symptom severity (P<0.05). This study examined two types of disease-specific self-efficacy in patients with COPD and demonstrated that improving self-efficacy is an important outcome of self-management interventions. Studies in other domains of self-efficacy are needed.

Cross-cultural adaptation of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus: Scale development

BACKGROUND

As a profession, nurses are particularly concerned with cross-cultural influences that affect the health practices of populations. Although the international literature describes questionnaires and specific scales in health and disease behaviours, adequate Turkish-language instruments are scarce. Therefore, suitable Turkish-language instruments need to be developed or adapted for the Turkish population.

OBJECTIVES

Study aim was to adapt a Dutch/English version of the diabetes management self-efficacy (SE) scale for use with a Turkish population and evaluate its psychometric properties.

DESIGN

Methodological research design.

SETTINGS

Attendants of an outpatient clinic of a university hospital in Turkey.

PARTICIPANTS

A convenience sample of 110 patients with type 2 diabetes mellitus (DM).

METHODS

Translation and back-translation of the original English instrument and content validation through a expert panel were the first two steps of the study. Third step was the psychometric testing of the adapted instrument by establishing internal consistency (Cronbach's alpha), stability (test-retest reliability), and construct validity (factor analysis).

RESULTS

Content validity procedure resulted in a final scale that consisted of 20 items. Internal consistency of the total scale was coefficient alpha=0.88, and test-retest reliability with a 4-week time interval was r=0.91 (p<0.001). Factor analysis yielded three factors related to diet, exercise and medical treatment. Two relevant items of the scale, weight control and blood sugar control, however, had low reliability and validity scores.

CONCLUSIONS

Although acceptable levels of reliability and validity of the Turkish version of the diabetes management SE scale for people with type 2 DM were reached, cultural factors appeared to play a role in the applicability of some items of the scale.

Preparing Nurses for the Global Pandemic of Chronic Obstructive Pulmonary Disease

PURPOSE

To raise awareness of the global pandemic of chronic obstructive pulmonary disease (COPD), its multiple underlying causes, and how to fight it, with particular attention to needs in nursing education.

METHODS

Integrative review of the literature.

FINDINGS

The main underlying causes of COPD are both individual and environmental factors, and the disease usually results from an interaction between these two factors. The prevalence of COPD is highest in countries where cigarette smoking has been, or still is, very common, and it is lowest in countries where smoking is less common, or total tobacco consumption per person is low. COPD is to some extent a preventable disease especially by preventing exposure to tobacco smoke and to occupational dusts and chemicals including vapours, irritants, fumes, and indoor and outdoor air pollution. The main implication for nurses and nursing curricula is to expand the focus from the individual to include population-based intervention programmes.

CONCLUSIONS

Addressing the underlying causes of COPD and providing appropriate interventions are within the scope of nursing practice and responsibility. Changes in nursing education are needed for nurses to be able to address the COPD pandemic.

Effect of education on self-efficacy of Turkish patients with chronic obstructive pulmonary disease

This study was designed to compare the effect of structured education on self-efficacy in patients with chronic obstructive pulmonary disease (COPD). The study was carried out with an experimental group on which a structured education was provided, and a control group on which only educational advice was provided. There were 30 patients in both groups. Control and experimental group measurements were obtained on the COPD Self-Efficacy Scale (CSES). There was a significant difference between control group and experimental group scores on the CSES. Self-efficacy, as it affects managing or avoiding breathing difficulty, was measured before and after the structured education program and the nursing care. Patients' self-efficacy scores significantly improved after the structured education and remained significantly improved 1-month later. Standard nursing care alone was also effective in significantly improving self-efficacy scores, but patients' scores 1-month later were not significantly better than pre-program scores. This study indicates that a planned education program that is more effective in improving self-efficacy in patients with COPD.

Functional and self-efficacy changes of patients admitted to a Geriatric Rehabilitation Unit

BACKGROUND

Geriatric Rehabilitation Units (GRUs) have been established to restore functional abilities of older hospitalized patients. Although considerable health care resources have been allocated to these units, few outcome-based research studies have been reported on Canadian GRUs.

AIM

The aim of this paper is to report a study examining the effect of admission to a GRU on changes in patients' functional ability and self-efficacy in performing everyday activities at home.

METHODS

Following Institutional Review Board approval, data were collected from 40 patients age 65-101 years (mean 83.8, sd 6.57) admitted to a 21-bed interdisciplinary GRUs over a 7-month period. All were living independently prior to hospital admission. Data were collected on admission to the unit and on discharge using two instruments: the Functional Independence Measure and Falls Efficacy Scale.

RESULTS

Statistically significant improvements were found in functional ability and self-efficacy following admission to the GRUs.

CONCLUSIONS

Although functional level and feelings of self-efficacy on admission to the unit were at levels which may have prevented participants from returning home, the majority were discharged to the community. Results suggest that admission to a GRU helps prepare patients to return to community living.

Adaptation to disability in chronic obstructive pulmonary disease: neglected relationships to older adults' perceptions of independence

PURPOSE

This study extends understanding of the relationship between disability and independence in older adults with COPD.

METHODS

An interviewer-administered questionnaire was used to examine disability, adaptation, perceptions of independence, and self-efficacy in a sample of 50 community-dwelling older adults. Odds ratios were used to investigate relationships between variables.

RESULTS

Participants used a wide range of behavioural strategies to adapt to their disability including: limiting activities, optimizing performance (e.g. taking rests), compensating for lost function (e.g. using equipment), and obtaining help from others. The relative use of these adaptations varied across five domains of activity: personal care, in-home mobility, household activities, community mobility, and valued activities. Most participants felt very or extremely independent in all domains. In personal care, those who reported greater disability (O.R. = 0.26), more frequent attempts to optimize performance (O.R. = 0.57), or greater reliance on help from others (O.R. = 0.79) were significantly (p < 0.05) less likely to feel very or extremely independent.

CONCLUSIONS

The relationship between disability and perceptions of independence depends on the nature of the activity and is influenced by factors that are amenable to study and intervention. In particular, the vast array of behavioural strategies available to older adults with COPD enables them to feel highly independent despite disability.

Self-management education for chronic obstructive pulmonary disease

BACKGROUND

In asthma, self-management programmes have been proven to be effective. In COPD, their value is not clear.

OBJECTIVES

To assess the efficacy of COPD self-management/ education programmes on health outcomes and use of health services

SEARCH STRATEGY

We searched the Cochrane Airways Group trial registers, MEDLINE (January 1985 to October 2001), reference lists, and abstracts of medical conferences. We also contacted research groups in the field for ongoing trials and unpublished material.

SELECTION CRITERIA

Controlled trials (randomised and non-randomised) of self-management education in patients with COPD. Studies focusing mainly on physical pulmonary rehabilitation were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Investigators were contacted for additional information.

MAIN RESULTS

The reviewers included 12 articles describing 8 randomised-controlled trials and 1 controlled clinical trial. Self-management education was compared with usual care in 8 studies. The studies in this review assessed a broad-spectrum of outcome measures with different follow-up times. Synthesis of the results using meta-analysis was always not possible. The studies showed no effect of self-management education on hospital admissions, emergency room visits, days lost from work and lung function. Inconclusive results were observed on health-related quality of life (HRQoL): studies using the disease specific SGRQ showed a better quality of life in the patients in the intervention group, but only in the activity component where there was heterogeneity between the results of the two included studies. A potential reason for the absence of convincing effects on HRQoL is the limited use of COPD-specific instruments. Inconclusive results were observed on COPD-symptoms and use of other health care resources such as doctor and nurse visits. Self-management education reduced the need for rescue medication, and led to an increased use of courses of oral steroids and antibiotics for respiratory symptoms.

REVIEWER'S CONCLUSIONS

The data available for this review are insufficient for forming recommendations. Further research on the effectiveness of self-management programmes should be focussed on behavioural change evaluated in well designed randomised controlled trials with standardised outcomes designed for use in COPD patients, and with long follow-up time so that definite conclusions can be made.

The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease

From a biomedical perspective, variations in the quality of life of chronic obstructive pulmonary disease (COPD) patients may be attributed to changes in pulmonary function; thus, an increase in lung function should be correlated with an increased score on a health-related quality-of-life measure. However, inconsistent results regarding correlations between various measures of pulmonary function and quality of life have been reported in the literature. The authors evaluated a social cognitive model of quality of life among persons with COPD by analyzing relationships among biomedical measures, self-efficacy measures, and quality-of-life measures in a recursive path model. Path analysis results indicated that the association of pulmonary function and symptoms with quality of life was mediated by perceived self-efficacy for functional activities.

Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma

PURPOSE

The purpose of this study was to examine the relationship between knowledge, attitudes, and self-efficacy and compliance with prescribed medical regimen, number of emergency department (ED) visits, and hospitalizations in adults with asthma.

METHOD

The sample consisted of 29 adults with a diagnosis of asthma. The relationship among knowledge, attitudes, self-efficacy, and compliance with medical regimen was explored through use of a survey design. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire and the Asthma Management Questionnaire that measured compliance were mailed to subjects' homes. Once completed, questionnaires were returned, and demographic data and number of ED visits and hospitalizations were obtained through a retrospective chart review.

RESULTS

There was a significant correlation between knowledge and attitudes and knowledge and self-efficacy. The more positive persons' attitudes toward their asthma, the higher their knowledge and self-efficacy scores. There were significant correlations between select demographic variables and knowledge, attitude, and self-efficacy. Women scored higher on attitudes, persons with a college education scored higher on knowledge and attitudes, and persons with mild asthma scored highest on the self-efficacy scale. Compliance with use of peak-flow meters correlated with higher scores on the attitude and self-efficacy scales. The higher total compliance score group had significantly higher self-efficacy scores. In addition, higher self-efficacy scores correlated with lower numbers of hospitalizations.

CONCLUSION

Attitudes and self-efficacy rather than knowledge had the most significant impact on compliance and number of ED visits and hospitalizations. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire provides a means for nurses to assess patients' knowledge, attitudes, and self-efficacy regarding their asthma. Patients with low scores could be channeled into programs that would help them improve their ability to manage their asthma.

A prediction model of aerobic exercise in older adults living in a continuing-care retirement community

OBJECTIVES

The purpose of this study was to test a model of exercise behavior in older adults. It was hypothesized that gender, marital status, chronic illness, mental and physical health, self-efficacy and outcome expectations, fear of falling, and past exercise behavior were directly and/or indirectly associated with current exercise behavior.

METHODS

In this descriptive study, interviews were conducted with 201 older adults living in a continuing-care retirement community.

RESULTS

Twelve paths were significant, and the model accounted for 40% of the variance in exercise behavior. Self-efficacy expectations, outcome expectations, and prior exercise were directly associated with current exercise; health status, gender, and marital status were indirectly associated with current exercise behavior through self-efficacy and outcome expectations.

DISCUSSION

Recognizing and treating mental and physical health problems may directly influence self-efficacy and outcome expectations related to exercise. Moreover, interventions that strengthen self-efficacy and outcome expectations related to exercise may improve exercise behavior.

Efficacy beliefs in geriatric rehabilitation

Motivation is an important variable in older adults' ability to recover from any disabling event. The theory of self-efficacy states that efficacy beliefs affect behavior, motivational level, thought patterns, and emotional reactions in response to any situation. This study explored the impact of efficacy beliefs on older adults in a rehabilitation program and tested interventions to strengthen efficacy beliefs related to participation in rehabilitation and functional performance. An experimental pretest-posttest design was used. Participants were randomly assigned to: the usual care control group or the treatment group. The study was completed on an inpatient geriatric rehabilitation unit. The sample consisted of 77 participants, 55 women and 22 men with a mean age of 78 +/- 7.2. Individuals in the treatment group received three efficacy enhancing interventions: role modeling, verbal persuasion, and physiological feedback. Baseline data were collected within 48 hours of admission and included four investigator-developed efficacy measures: Functional Inventory Measure, Participation Index, Numeric Rating Scale for pain, amount of analgesic used for pain, and Health Status. With the exception of Health Status, these measures were again completed within 48 hours of discharge. Admission performance was the only statistically significant predictor of efficacy beliefs. All efficacy beliefs increased over time and were significantly correlated with performance behaviors and length of stay. The treatment group had stronger efficacy beliefs regarding participation, higher participation at discharge, and less pain than the control group. Efficacy beliefs, both self-efficacy and outcome expectations, are related to participation, functional performance, and length of stay. Interventions to strengthen these beliefs improved participation in rehabilitation and decreased pain. Consideration of motivation can facilitate rehabilitation and help older adults obtain and maintain their highest functional level.

The effects of education alone and in combination with pulmonary rehabilitation on self-efficacy in patients with COPD

This study compared the effects on self-efficacy of participation by patients with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation program that combined education and supervised exercise training with the results demonstrated by participation in a program that provided education alone. Thirty-seven patients participated in the pulmonary rehabilitation program, and 22 patients participated in the education-only program. Self-efficacy, as it effects managing or avoiding breathing difficulty, was measured before and after the programs. Patients' self-efficacy scores significantly improved after the pulmonary rehabilitation program and remained significantly improved 6 months later. Education alone was also effective in significantly improving self-efficacy scores, but patients' scores 6 months later were not significantly better than preprogram scores. This study indicates that a rehabilitation program that combines education and exercise training is more effective in improving long-term self-efficacy in patients with COPD.