Relationship between symptoms and functional performance in COPD

We studied the relationships among functional performance and three symptoms--dyspnea, fatigue, and sleep difficulty--in a sample of 100 people with chronic obstructive pulmonary disease (COPD). All participants had an FEV(1) 60% or less of the predicted level for age, sex, and height. Consistent with the Theory of Unpleasant Symptoms, dyspnea correlated with both fatigue and sleep difficulty. Dyspnea and fatigue both had moderate negative correlations with functional performance, while sleep difficulty had a small nonsignificant negative correlation with functional performance. After controlling for age and oxygen use, dyspnea was the only symptom to predict variance in functional performance significantly. Of the three symptoms studied, only dyspnea was related to both the other symptoms and to functional performance. Focusing on dyspnea may be the best way to improve both symptom experience and functional performance in people with COPD.     

Pathophysiology of dyspnea in COPD

Dyspnea refers to the sensation of breathlessness, shortness of breath, or difficulty breathing that is commonly observed in patients with respiratory and cardiac disease. In the United States alone, dyspnea is reported in up to 4 million all-cause emergency room visits annually. Dyspnea can be a symptom of several different underlying physical conditions, typically involving the lung and heart. Indeed, it is an important symptom in chronic obstructive pulmonary disease (COPD), where it is associated with limited physical activity, increased anxiety and depression, decreased health-related quality of life (HRQoL), and reduced survival. Currently there is no single physiological correlate that will accurately predict dyspnea, particularly because the mechanisms that contribute to respiratory discomfort can vary between diseases and between individuals experiencing breathlessness who have been diagnosed with the same disease. Therefore, various subjective clinical and psychophysical scales and questionnaires are typically used to measure or predict dyspnea. It is the goal of this review to discuss the pathophysiological mechanisms leading to dyspnea, particularly those associated with COPD, the physical and psychological impact on patients, assessment approaches, and modalities currently used to treat it.     

Danish version of 'The COPD self-efficacy scale': translation and psychometric properties

The aim of the study was to translate 'The COPD self-efficacy scale' (CSES) into Danish and to evaluate the psychometric properties of the Danish version (CSES-DK). CSES enables assessment of self-efficacy in individuals with chronic obstructive pulmonary disease (COPD). The scale consists of 34 items, describing situations which may cause dyspnoea in patients with COPD. The CSES was translated into Danish using a standard forward-backward translation procedure. To estimate the reliability, measurements of internal consistency and repeatability were applied. The validity of the Danish version was evaluated by examining the associations between the CSES-DK score and socio-demographic variables (age, gender, education, disease severity and self-rated health). Factor analysis was conducted to compare the internal structure of the Danish version and the American source version. The study included 151 patients with COPD, recruited from three outpatient clinics. Estimates of reliability were in accordance with the original version of CSES (Cronbach's α = 0.97, test-retest r = 0.82, p < 0.001). Significant correlations were obtained between the CSES-DK total score and vocational training and education (r = 0.27, p = 0.001), disease severity (r = -0.27, p = 0.001) and self-rated health (r = -0.41, p < 0.001), indicating construct validity. Five factors were extracted from both versions of CSES. However, in the CSES-DK, only one factor concerns emotions, whereas two factors describing emotions were obtained for the original scale. Furthermore, important discrepancies exist with respect to the direction of the scoring of CSES. In some studies, a high score indicates high self-efficacy, whereas it indicates low self-efficacy in other studies, which complicates the comparison of studies. The Danish version of CSES showed acceptable measurements of reliability and validity. Potential limitations of the scale were identified, and discrepancies exist between the factor structure of the original and Danish version. Consequently, more studies of the factor structure should be conducted on both the original CSES and the translated versions of the instrument.     

Additional evidence for the affective dimension of dyspnea in patients with COPD

The primary purpose of this secondary analysis was to determine whether 103 participants with chronic obstructive pulmonary disease rated the affective dimension of dyspnea (dyspnea‐related anxiety and dyspnea‐related distress) separately from the sensory dimension (intensity) during baseline exercise testing conducted as part of a randomized clinical trial. A secondary purpose was to determine if dyspnea‐related anxiety and distress were rated distinctly different from other measurements of anxiety. At the end of a 6‐minute walk and an incremental treadmill test, participant ratings of the magnitude of dyspnea‐related anxiety and distress on the Modified Borg Scale were significantly different from their ratings of the intensity of dyspnea. Dyspnea‐related anxiety and distress also appeared to be concepts independent from measures of state anxiety, negative affect, and anxiety before a treadmill test. © 2009 Wiley Periodicals, Inc. Res Nurs Health 33:4–19, 2010     

Predictors of Functional Performance in Community-Dwelling People with COPD

PURPOSE: To identify physiologic, well-being, and coping resource predictors of functional performance in community-dwelling people with COPD. DESIGN: A cross-sectional, correlational design was used with a convenience sample of 119 people who received care in a private pulmonary medicine practice. METHODS: Participants were recruited in person, completed the study instruments at home, and returned the instruments to the researcher by mail. Pulmonary function test results were obtained from medical records. Univariate, bivariate, and multiple regression analyses were performed. FINDINGS: Several bivariate correlations were robust, particularly among the well-being and coping resource variables, but none were large enough to indicate multicollinearity. Four proposed predictors (depression, severity of pulmonary disease, age, and gender) explained 46.3% of the variance in functional performance. CONCLUSIONS: Functional performance was influenced by both physiologic and negative well-being factors. Because of the potential influence of depression on adherence to medical regimen, attention to both physical and mental health is necessary for maintaining optimal health and functioning in these chronically ill people.     

Evaluating functional activity in older Thai adults.

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.     

Effectiveness of a self-efficacy program for persons with diabetes: a randomized controlled trial

The aim of this study was to examine the effects of a self-efficacy program for persons with type 2 diabetes in Taiwan. A randomized controlled trial was designed (n = 145), with 72 participants in the intervention group and 73 in the control group. The participants were pretested to establish a baseline and then post-tests were undertaken 3 and 6 months after the baseline data were collected. The participants in the intervention group received the standard diabetes education program and an additional self-efficacy program. The scores for efficacy expectations, outcome expectations, and self-care activities had significantly increased in the intervention group at the 3 and 6 month follow-ups, when compared to those of the control group. A smaller proportion of the participants in the intervention group had been hospitalized or had visited an emergency room than in the control group at the 6 month follow-up. This study revealed that a self-efficacy program for diabetes was acceptable and effective in the short term in the self-management of persons with type 2 diabetes.     

Reliability and validity of the continence self-efficacy scale in Turkish women with urinary incontinence

This study investigated the psychometric properties of the Continence Self-Efficacy Scale. Data was collected from 128 women who had urinary incontinence using the following instruments: the Continence Self-Efficacy Scale, the Broome Pelvic Muscle Exercise Self-Efficacy Scale, the International Consultation on Incontinence Questionnaire Short Form, and the Beck Depression Inventory. The validity of the Continence Self-Efficacy Scale was investigated using confirmatory factor analysis and convergent and divergent validity analyses. The reliability of the Continence Self-Efficacy Scale was examined in terms of internal consistency and test-retest correlations. Confirmatory factor analysis indicated a three -factor model that had acceptable goodness-of-fit indices. The convergent validity of the Continence Self-Efficacy Scale was supported by a positive correlation between the Continence Self-Efficacy Scale and the Broome Pelvic Muscle Exercise Self-Efficacy Scale. The divergent validity of the Continence Self-Efficacy Scale was supported by negative relationships between the Continence Self-Efficacy Scale and the Beck Depression Inventory. The Cronbach's alpha values regarding internal consistency were 0.94 for the overall scale and 0.92-0.93 for the subscales. Test-retest correlations were 0.75 for the overall scale and 0.52-0.74 for the subscales. The Continence Self-Efficacy Scale is a valid and reliable instrument for use in Turkish women with urinary incontinence.     

Using self-efficacy theory to educate a patient with chronic obstructive pulmonary disease: A case study of 1-year follow-up

Self-efficacy is important in determining which activities or situations an individual will perform or avoid. This is a case study report to explore the utility of structured education programme on strengthening self-efficacy in an older adult with chronic obstructive pulmonary disease (COPD). To comprehensively evaluate this intervention, a combined qualitative and quantitative approach was used. Although qualitative data were collected following the interview guide, quantitative data were collected by the demographic data form and the COPD Self-Efficacy Scale (CSES) at the preprogramme and postprogramme stage. The patient's self-efficacy scores improved after 8 weeks of the structured education programme and remained relatively constant on all the repeated measurements after education. Qualitative data were identified as 'difficulties' and 'facilities'. This study indicates that, by applying a self-efficacy theory, a planned education programme could be useful in improving both short-term and long-term self-efficacy in patients with COPD.     

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period

Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.     

Stages of smoking acquisition of young Taiwanese adolescents: self-efficacy and decisional balance

The objective of this study was to assess relationships of the stages of smoking acquisition with self-efficacy and decisional balance in young Taiwanese adolescents. A random sample of 401 students was recruited. Students who were at the precontemplation stage had higher self-efficacy to resist smoking initiation than those who were at the decision-making or maintenance stages. Ratings of benefits of smoking were significantly higher for those in the maintenance stage than in the precontemplation or decision-making stages. In a discriminant function analysis, self-efficacy and decisional balance correctly predicted 77.4% of membership in the three stages. Health educators could use stage-specific skills and strategies based on self-efficacy and decision balance constructs to develop smoking prevention programs.