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

Understanding the impact of COPD and self-management interventions: a self-determination theory perspective

People with COPD (pwCOPD) experience a range of daily living limitations caused by breathlessness, which can affect their quality of life and physical and mental health. There are approximately 1.2 million pwCOPD in the UK. Two common behavioural interventions are self-management support and pulmonary rehabilitation, which support pwCOPD to exercise and adopt techniques to decrease their symptoms; however, adherence to these can be poor. This study aimed to understand whether these two different interventions can affect motivational concepts and explore how pwCOPD experience their condition and these interventions. This study used a mixed-method design. Participants were allocated to receive either: pulmonary rehabilitation and PocketMedic (a self-management intervention), only PocketMedic, or only pulmonary rehabilitation. Questionnaires measuring self-determination theory motivational concepts were completed at baseline and seven weeks. Semi-structured interviews were conducted and analysed using Reflexive Thematic Analysis. 53 participants were recruited to the three conditions. An ANOVA found no statistically significant differences between the groups for any of the questionnaires, which may be related to the low sample size. However, when the research condition was held constant, significant improvements were identified for competence satisfaction (p < 0.001) and relatedness satisfaction (p < 0.05) and autonomy frustration (p < 0.001) and competence frustration (p < 0.05). Seven participants from the PocketMedic conditions were interviewed. Overarching themes described the participants' experiences and adaptations to psychological need frustration, and how the interventions facilitated basic psychological need satisfaction. This study suggests that pulmonary rehabilitation and PocketMedic can improve basic psychological need satisfaction and frustration; however, there were no cumulative affects when the interventions were combined. Need frustration is important to consider in research on long-term conditions. The qualitative analysis provides greater knowledge on mechanisms by which healthcare interventions have been shown to be effective. Further research is needed including larger and more diverse samples to enable complete generalisability.

A retrospective study on the predictive efficacy of SOBDA and VSRQ scales for prognosis in elderly COPD patients

This retrospective study aimed to compare the predictive efficacy of the shortness of breath with daily activities (SOBDA) and ventilatory response to exercise questionnaire (VSRQ) in forecasting respiratory-related adverse events in elderly patients with chronic obstructive pulmonary disease (COPD) over a 6-month follow-up period post-discharge. A total of 92 COPD patients, treated according to the 2022 GOLD report and Chinese National COPD treatment guidelines, were enrolled. SOBDA and VSRQ scores were collected upon admission and assessed daily for the first 7 days. A random forest model was used to evaluate the predictive value of these scores in relation to respiratory adverse events, with a training/testing group split at a 4:1 ratio. Five patients were excluded due to loss to follow-up or death, resulting in 87 patients in the final analysis. The primary endpoint was the occurrence of COPD exacerbations and respiratory failure. The random forest model using VSRQ scores as the response variable outperformed the SOBDA model in terms of predictive accuracy (AUC: 0.84 vs 0.65) and error rate (21.74% vs 22%). Both models demonstrated high accuracy in predicting the absence of adverse events (VSRQ: 85.72%, SOBDA: 83.67%) but showed limited sensitivity in predicting their occurrence (VSRQ: 35%, SOBDA: 40%). The VSRQ questionnaire demonstrated superior predictive performance compared to SOBDA, suggesting that VSRQ may be a useful tool for identifying high-risk elderly COPD patients and guiding clinical decision-making. Further studies are needed to confirm these findings and explore the broader applicability of VSRQ in COPD prognosis.

Applying behavioral change theories to optimize pulmonary rehabilitation in COPD patients: A review

This review meticulously evaluates the integration of behavioral change theories into pulmonary rehabilitation programs for chronic obstructive pulmonary disease (COPD) management, addressing the critical need for enhanced patient compliance and improved therapeutic outcomes. With COPD posing significant global health challenges, characterized by high morbidity and mortality rates, the manuscript underscores the potential of Self-Determination Theory, Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, and the Theory of Planned Behavior to foster meaningful health behavior changes among patients. Through a comprehensive literature analysis, it reveals how each model contributes to understanding patient behaviors in pulmonary rehabilitation contexts, advocating for their systematic application to craft more effective, patient-centered interventions. Despite the proven efficacy of these theories in various health domains, their current underutilization in pulmonary rehabilitation underscores a gap between theoretical knowledge and clinical practice. The review calls for an interdisciplinary approach that bridges this gap, highlighting the urgency of developing actionable, theory-based behavioral intervention plans. By doing so, it aims to advance COPD management strategies, ultimately improving the quality of life for individuals living with this debilitating disease.

Self-Management Programs and the Pursuit of Behavior Change

A self-management intervention is a personalized approach to individuals aiming to engage individuals in a behavior change to develop skills to live better with their condition. Self-management involves an iterative process between participants and providers in which goals are formulated and feedback is given. All respiratory societies advocate self-management as part of chronic care because it may improve quality of life and health-care utilization. Self-management is an integral part of pulmonary rehabilitation. Self-management interventions usually involve education and exercise prescription, and that is an asset of current programs; however, recent reports indicate that effective strategies for motivation and a behavior change focus are often missed. A recent systematic review on self-management urges the need for a specific aspect and characteristic of self-management interventions: iterative interactions between participants and health-care professionals competent in using behavior change practices to elicit participants' motivation, confidence, and competence to develop skills to better manage their disease. A recent review of self-care intervention in chronic disease states that the major deficits found in self-care interventions included a lack of attention and/or innovation to the psychological consequences of chronic illness, technology, and behavior change techniques to help patients manage symptoms. There is a need for exploration of mechanisms to explain the relationships between both anxiety and depression, and adherence to treatment in COPD. The latter is particularly appropriate for pulmonary rehabilitation, for which greater adherence is needed. This report aims to introduce basic aspects of behavior change and a proposed roadmap to introduce behavior change into pulmonary rehabilitation and chronic care programs.

Factors associated with self-management after hybrid revascularization in patients with peripheral artery disease: A structural equations model

AIM

To investigate the factors associated with self-management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach.

DESIGN

A cross-sectional study was adopted.

METHODS

A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200-bed tertiary care hospital in Korea. Data were collected using a self-reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model.

RESULTS

The item mean score of participants' self-management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self-management (β = 0.20, p = 0.041). Illness perception directly (β = -0.33, p = 0.031) and indirectly (β = -0.19, p = 0.032) influenced self-management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self-management. The Sobel test confirmed the statistically significant mediating effects of competence (z = -4.52, p < 0.001) and relatedness (z = -2.12, p < 0.001) on the relationship between illness perception and self-management.

CONCLUSION

Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self-management. Additionally, patients' illness perception can indirectly influence self-management through their perceived competence and relatedness.

IMPACT

Healthcare providers' autonomy support to patients may promote self-care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self-management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers.

Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study

BACKGROUND

Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging.

RESEARCH QUESTION

To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program?

STUDY DESIGN AND METHODS

Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes.

RESULTS

One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss.

INTERPRETATION

Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear.

TRIAL REGISTRY

ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www.

CLINICALTRIALS

gov.

Self-management model based on information-motivation-behavioral skills model in patients with chronic obstructive pulmonary disease

AIM

To develop and test a predictive model of self-management based on the theory of the information-motivation-behavioural skills model and previous literature on self-management for patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A descriptive, correlational, cross-sectional design was used.

METHODS

A convenience sample recruited 248 patients with COPD from the pulmonary medicine clinic in South Korea between July 2020 and June 2021. We used self-administrated, structured questionnaires for dyspnoea, health status, knowledge, attitude, social support, self-efficacy and self-management. Data were analysed using path analysis to test a self-management model for patients with COPD.

RESULTS

Gender, COPD self-management knowledge, social support and COPD self-efficacy had a direct effect on COPD self-management. Dyspnoea, Global Initiative for Chronic Obstructive Lung Disease stage, health status, COPD self-management attitude and social support had an indirect effect on self-management in patients with COPD. These variables explained 43.2% of the total variance for self-management in patients with COPD.

CONCLUSIONS

When assessing self-management of COPD; demographic and clinical factors, knowledge, attitudes, social support and self-efficacy included in the information-motivation-behavioural skills model should be considered together.