Self-Efficacy Intervention Programs in Patients with Chronic Obstructive Pulmonary Disease: Narrative Review

The Impact of Chronic Obstructive Pulmonary Disease Severity on Psychological and Functional Outcomes: A Cross-Sectional Analysis

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by significant physical and psychological burdens. However, the influence of the disease's severity on psychological factors and functional outcomes remains unclear. This study aimed to investigate the impact of disease severity on psychological factors and functional outcomes in patients with moderate and severe COPD. Methods: This cross-sectional study included 98 patients with moderate (n = 44) or severe (n = 54) COPD. Anxiety and depression, guilt and shame, self-compassion, self-efficacy (PRAISE), and fear of negative evaluation were assessed. Functional capacity was evaluated with the six minute walk test (6MWT), and disease impact was assessed via the COPD assessment test (CAT). Lung function was measured through post-bronchodilator spirometry. Results: Compared with those with moderate COPD, those with severe COPD presented significantly greater levels of guilt (12 vs. 10; p < 0.01), anxiety (10 vs. 6.5; p < 0.01), and depression (7.5 vs. 6; p = 0.06). Self-compassion was significantly lower in the severe group (3.16 vs. 3.41; p < 0.01), whereas shame and fear of negative evaluation scores were similar between the groups. The functional capacity was significantly reduced in patients with severe COPD (217.04 ± 70.16 m vs. 286.46 ± 77.92 m; p < 0.01). Disease impact and dyspnea (CAT, mMRC) were worse in severe cases (p < 0.01). Conclusions: Patients with severe COPD presented significantly greater levels of guilt, anxiety, and depression, alongside lower self-compassion, worse functional outcomes, and poorer health-related quality of life, compared to those with moderate COPD.

"A new realization of what I'm able to do": exercise interventions can impact knowledge, confidence and daily activity for people with pulmonary arterial hypertension (PAH)

PURPOSE

Exercise-based rehabilitation interventions can improve functional outcomes in pulmonary arterial hypertension (PAH), but barriers to participation are common and little is known about the patient-reported experience. This study evaluated the patient experience of participating in structured, outpatient exercise interventions for PAH, and explored how participation may impact knowledge, attitudes and engagement in physical activity.

METHODS

A mixed-methods evaluation was conducted alongside a pilot trial (ExPAH). Semi-structured interviews were completed with participants who undertook a 12-week, outpatient exercise-based intervention for PAH. Interview data were analyzed via descriptive and inductive thematic analyses.

RESULTS

Fourteen participants were included (mean 53 ± 14.9 years, 79% females). Formal therapy programs were reported to be enjoyable and increased participant's knowledge, confidence to exercise, and daily physical activity. Six dominant themes described the subjective experience of undertaking a structured program: confronting a sense of loss and limitation through exercise; "permission to try" built knowledge and confidence; finding joy and empowerment through physical activity; the importance of motivation; reframing exercise as part of daily life; and exercise as liberating.

CONCLUSIONS

Structured therapy programs can increase knowledge, confidence, and positive perceptions of physical activity for people with PAH. Structured programs were reported to be enjoyable, empowering and increased functional independence.

Effects of Heart Rate Variability Biofeedback on Enhancing Self-Efficacy, Quality of Life and Six-Minute Walking Test in Patients with Chronic Obstructive Pulmonary Disease

Heart rate variability biofeedback (HRVB) is a bio-behavioral intervention applied to patients with chronic obstructive pulmonary disease (COPD), and improves their autonomic activation and pulmonary function. This study explored the effects of HRVB on self-efficacy, quality of life, depression, anxiety, and heart rate variability (HRV) indices under the Six-Minute Walking Test (6MWT) in patients with COPD. The study hypothesizes that HRVB can improve self-efficacy and quality of life, reduce depression and anxiety, and decrease HRV reactivity while enhancing HRV recovery during the 6MWT. A total of 53 patients with COPD were assigned to either an HRVB group (n = 26) or a control group (n = 27), both received standard medical care. The HRVB group also participated in one hour weekly for six weeks. All participants completed assessments using the COPD Self-Efficacy Scale, St. George's Respiratory Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory pre-test and post-test. The 6MWT was administered to measure HRV during baseline, walking, and recovery stages. Significant improvements in self-efficacy and quality of life for the HRVB group, with a significant increase in post-test compared to pre-test and the control group. However, there were no significant differences in changes in depression and anxiety between the two groups. Additionally, the HRVB group exhibited a significant decrease in HRV reactivity and increased HRV recovery at the post-test compared to the pre-test. These findings indicated that HRVB effectively enhances self-efficacy and quality of life in patients with COPD while improving autonomic function. Therefore, HRVB could be a valuable component of pulmonary rehabilitation for patients with COPD.

Nurse-Led/Involved Home-Based Interventions for Older Adults With Chronic Obstructive Pulmonary Disease (COPD): A Mixed-Methods Systematic Review

AIMS

To determine the effectiveness of nurse-led/involved home-based interventions for older people with COPD and to explore the experiences of older people and nurses with the interventions.

DESIGN

A mixed-methods systematic review following the JBI methodology for mixed-methods systematic reviews.

DATA SOURCES

The search included relevant and peer-reviewed studies published from January 2010 to December 2023 in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, JBI, EMCARE and ProQuest.

REVIEW METHODS

English-language reports of nurse-led/involved home-based interventions for people with COPD were included based on authors' consensus. Three reviewers performed independent quality appraisal using JBI tools. A convergent segregated approach was used for data synthesis and integration.

RESULTS

Seven interventions were identified in two mixed-methods, two qualitative, two quasi-experimental studies, and one secondary analysis from a randomised control trial. The effectiveness of the interventions was measured with various outcomes and was effective to some extent, with reduced hospitalisation, hospitalisation days, hospitalisation cost and all-paid claims. However, the outcomes were not statistically significant, and the effectiveness was inconclusive. While patients appreciated support and resources, some perceived them as a double-edged sword.

CONCLUSIONS

Patients preferred more holistic interventions over extended periods. The inconclusive findings and limitations warrant further research with larger sample sizes and comparable measurement tools and outcomes.

IMPACT

This is the first mixed-methods systematic review on the effectiveness of home interventions for people with COPD with a clear definition of 'nurse-led'. Nurses felt highly valued by patients and other health professionals; however, they reported a lack of support from management. The lack of interventions led by nurses challenges them to lead, deliver and evaluate what matters to people with COPD.

REPORTING METHOD

This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Understanding the Determinants and Outcomes of Education in Pulmonary Rehabilitation: Moving Toward Person-Centered Care

TOPIC IMPORTANCE

Education and psychosocial support are essential components of pulmonary rehabilitation (PR). However, the delivery of education often follows a one-size-fits-all approach, with individual factors that influence learning rarely considered. Moreover, education-related outcomes are frequently overlooked in PR assessments, and their inconsistent use has limited our understanding of education's impact on people with chronic respiratory diseases. There is a clear need for practical guidance to identify key learning determinants and to define targeted education outcomes, ultimately optmizing PR and establishing quality standards.

REVIEW FINDINGS

Cognitive function, health literacy, psychological status, and social connection can influence an individual's ability to learn. Without proper consideration and assessment, these factors can otherwise become barriers to education and effective self-management. Education in PR should aim to: (1) improve individuals' knowledge to foster informed and active participants; (2) develop their skills to enable autonomy and competence; and (3) enhance their confidence to apply this knowledge and skills in daily life.

SUMMARY

This review emphasizes the importance of person-centered education in PR, provides a framework for understanding which education-related outcomes to target, and highlights the need for future research to enhance this essential component.

Interactive 3D visualisation technique used in pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled study evaluating quality of life, compliance and use of health care

Introduction

A pulmonary rehabilitation (PR) programme, including exercise training, education, and behaviour change, is highly recommended in treatment guidelines for chronic obstructive pulmonary disease (COPD). A new PR educational material for PR using an interactive three-dimensional (3D) visualisation technique was developed. There is little known regarding using 3D in this setting. The aim was to evaluate, within a PR programme setting, differences between outcomes of education through interactive 3D compared with education by means of 2D visualisation in patients with COPD regarding health-related quality of life (HRQL), physical capacity, exercise self-efficacy, compliance to exercise training, compliance to medication, and the use of health care and to describe learning styles.

Methods

Patients were cluster randomised to PR at the University Hospital clinic, including exercise training, for 10 weeks with education by 3D (n = 27) or education by traditional 2D technique (n = 17). At follow-ups, HRQL, physical capacity, self-efficacy, handgrip strength, compliance to exercise training, compliance to medication and health care utilisation were assessed.

Results

No significant differences were observed in HRQL in relation to COPD between the groups after 10 weeks. Differences were found in handgrip strength at baseline and at 10 weeks (p < 0.01). The 3D group had improved scores in HRQL assessed with the Leicester Cough Questionnaire (LCQ-S) psychological domain (p = 0.022). In the 2D group, the LCQ-S social domain (p = 0.028), psychological domain (p = 0.021) and the St George's Respiratory Questionnaire total (p = 0.050) were increased. The most common learning mode and learning style in both groups was reflective observation and divergent style.

Conclusion

An interactive education in 3D technique used in a PR programme for patients with COPD yielded no significant differences compared to conventional techniques. Three-dimensional techniques can be used in PR for COPD as an alternative to conventional techniques. ClinicalTrials.gov (identifier:NCT02802618).

The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis

BACKGROUND

Chronic diseases significantly impact global morbidity and mortality, affecting millions. Self-management interventions are crucial for improving patient health outcomes. This study explores the effects of self-management interventions on the quality of life (QOL), self-efficacy, depression, and anxiety of patients with chronic diseases.

METHODS

Relevant studies were searched from PubMed, EMBASE, and Web of Science. Two reviewers independently screened the literature, evaluated the risk of bias assessment, and extracted characteristics and outcomes among patients with chronic diseases. For each included study, we calculated the standardized mean difference (SMD) and 95% confidence interval (CI) of the main outcomes. When deemed feasible, the heterogeneity of the study was explored by meta-analysis and subgroup analysis.

RESULTS

Thirty-four studies involving a total of 7603 patients with chronic diseases were included. Self-management interventions significantly improved quality of life (Higher-better QOL and Lower-better QOL), self-efficacy, and reduced depression symptoms compared to usual care (95%CI 0.01 to 0.15, p = 0.03; 95%CI -0.49 to -0.08, p = 0.006; 95%CI 0.19 to 0.62, p < 0.001; 95%CI -0.23 to -0.07, p < 0.001). However, no significant effect was found for anxiety (95%CI -0.18 to 0.03, p = 0.18). In the heterogeneity analysis, Lower-better QOL and self-efficacy were all higher than 50% (I2 = 80%, 87%). After the subgroup analysis, the heterogeneity of Lower-better QOL and self-efficacy was less than 50% (I2 = 0%, 16.1%). Subgroup analyses revealed that studies with mean age greater than 60 years old and follow-up times greater than 6 months were more effective in improving patients' Lower-better QOL (p = 0.03, p = 0.004), whereas follow-up times less than 6 months were better at reducing patients' anxiety symptoms (p = 0.03).

CONCLUSIONS

Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients' quality of life, self-efficacy, and reducing depressive symptoms, but they did not show significant improvements in anxiety symptoms. Overall, self-management interventions for chronic diseases can help patients adapt to the changes brought about by the disease and self-manage diseases to prevent disease progression.

Psychometric testing of the cross-culturally adapted Thai version of the Self-Care Self-Efficacy Scale version 3.0 in individuals with chronic illnesses

Objective

To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0 (SCSES-v3.0) in individuals with chronic illnesses. Although originally developed and tested in a Western context, its applicability in Asian populations, including Thailand, remains inadequately explored.

Methods

Psychometric tests were guided by COSMIN principles. This included the translation of the English version into Thai based on the ISPOR framework. Nine nursing experts evaluated the content validity. Data were obtained from a multicenter cross-sectional study conducted between July and November 2022. This study included individuals with chronic conditions from 16 primary care centers in Thailand. We tested the structural validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c (SC-CII-v4.c). We tested the scale's reliability with McDonald's ω, Cronbach's α, and the intraclass correlation coefficient (ICC).

Results

The Thai SCSES-v3.0 demonstrated excellent content validity (k = 1.00). The final analysis included a total of 385 participants. The EFA with the first split-half subsample (n = 193) extracted a two-factor structure. One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors (item 6-10). CFA with the second split-half subsample (n = 192) and the overall sample (n = 385) supported the scale's two-factor model with high factor loadings. Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c. McDonald's ω and Cronbach's α (both ranged 0.91-0.94) and ICC (ranged 0.95-0.96), indicated excellent internal reliability and test-retest reliability, respectively.

Conclusions

The identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators, facilitating the assessment of self-efficacy in self-care across diverse contexts.

A Chinese version of the infertility self-efficacy scale: Reliability and validity assessment

Objective

To translate, cross-culturally adapt and test the reliability and validity of a Chinese version of the Infertility Self-Efficacy scale.

Methods

The Infertility Self-Efficacy (ISE) scale was translated into Chinese using forward and backward translations, expert consultation, cognitive interviews and a pilot study. To test the scale's reliability and validity, 515 infertile women in two hospitals were recruited to evaluate the Chinese version of the scale. Content validity was assessed by means of expert consultation. Exploratory factor and confirmatory factor analyses were performed using SPSS 26.0 and Amos 24.0. Reliability tests of the scale included Cronbach's alpha coefficient, split-half reliability and test-retest reliability.

Results

The Chinese version of the ISE scale contains 16 items and one dimension. Content validity of the scale was 0.96. Results of exploratory factor analysis suggested that the one factor model was suitable for the scale, and factor loading of all items was greater than 0.4. Model fitting parameters of confirmatory factor analysis of the ISE scale were χ2/df = 2.710, Root Mean Square Error Approximation (RMSEA) = 0.079, Standardized Root Mean Square Residual (SRMR) = 0.042, Comparative Fit Index (CFI) = 0.953, and Tucker-Lewis Index (TLI) = 0.939. Cronbach's alpha coefficient of the Chinese ISE was 0.980; split-half coefficient was 0.972 and retest reliability was 0.848 (P < 0.01).

Conclusion

The Chinese ISE scale is a reliable and valid instrument to evaluate the self-efficacy of infertile Chinese women.

Wound healing rates in COPD patients undergoing traditional pulmonary rehabilitation versus tailored Wound-Centric interventions

This comparative cross-sectional study, conducted at Shanghai Pulmonary Hospital, aimed to evaluate the efficacy of tailored wound-centric interventions (TWCI) versus traditional pulmonary rehabilitation (TPR) in enhancing wound healing in patients with chronic obstructive pulmonary disease (COPD). Enrolling 340 patients with confirmed COPD, the study randomly assigned participants to either the TWCI or TPR group for a 12-week programme. The primary outcome measured was the rate of wound healing, with secondary outcomes including changes in pulmonary function tests (PFTs) and quality of life (QoL) scores. The TWCI group received a customized programme integrating standard pulmonary rehabilitation with specific wound care strategies, such as enhanced oxygen therapy, nutritional supplementation, and infection control measures. In contrast, the TPR group underwent a conventional pulmonary rehabilitation programme without targeted wound care interventions. Wound healing rates, PFTs, and QoL scores were assessed at the end of the intervention and 3 months post-intervention. The TWCI group demonstrated a statistically significant improvement in wound healing rates compared with the TPR group. The TWCI group had a 15% higher rate of reduction in wound size, a 10% rise in complete healing rates, and a 20% drop in infection rates (p < 0.05). Specifically, TWCI group exhibited higher rates of wound size reduction, complete healing, and decreased infection rates. Additionally, long-term pulmonary function and overall quality of life improvements were more pronounced in the tailored group, underscoring the benefits of a personalized approach to managing COPD and wound care. The study concluded that integrating wound-specific care strategies with pulmonary rehabilitation significantly enhances health outcomes in COPD patients with wounds. These findings supported the adoption of customized, multidisciplinary care plans, suggesting that tailored interventions can offer a comprehensive solution to the complex needs of COPD patients, potentially redefining best practices in chronic disease management.

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change

BACKGROUND

Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners.

OBJECTIVE

This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models.

METHODS

This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy.

RESULTS

The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression.

CONCLUSION

These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Quality of life in the older adults: The protective role of self-efficacy in adequate coping in patients with chronic diseases

The purpose of the present study was to establish the association between self-efficacy, perception of disease, emotional regulation, and fatigue and the health-related quality of life in older adults living in the departments of Cesar and Atlántico in Colombia and who have been diagnosed with a chronic disease. The participants were 325 older adults of both sexes, with literacy and no presence of cognitive impairment in the Mini-Mental State Examination (MMSE); A non-probabilistic sampling was carried out. We used the MOS-SF-36 questionnaire, the Brief Illness Perception Questionnaire scale for measuring the perception of disease, the Stanford Patient Education Research Center’s Chronic Disease Self self-efficacy questionnaire for chronic patients, the Difficulties in Emotional Regulation Scale, and the Fatigue Severity Questionnaire as measurement instruments. The design was non-experimental cross-sectional with a correlational scope. The results indicate that self-efficacy, disease perception, emotional regulation and severity of fatigue are variables that could impact the physical function of quality of life, confirming that self-efficacy would work as a factor that decreases the probability that a participant score low on this dimension of quality of life. On the other hand, both the perception of the disease and the severity of fatigue were identified as factors that probably negatively influence quality of life.

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.