Anne-Marie Selzler

Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Predictors of Program Completion and Success

Abstract Although participation in pulmonary rehabilitation (PR) improves the health outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD), there are insufficient resources to provide PR to all patients with COPD. Thus, predicting which patients are at risk for drop-out and non-response to rehabilitation is necessary in order to optimize limited resources. This study examined which patient characteristics are predictive of PR drop-out and non-response. 814 patients with COPD took part in standard out-patient PR for 8 weeks. Demographic and standard clinical data were collected before the rehabilitation program had started. Data was analyzed retrospectively to determine if baseline patient characteristics could predict drop-out and non-response to rehabilitation. Drop-out was defined as participation in less than 50% of the rehabilitation sessions. Non-response was defined as improvement less than 4% on the St. Georges Respiratory Questionnaire (SGRQ). A discriminant function analysis identified age, smoking history, and health status as predictors of patient drop-out, p < .0001, with younger, current smokers and patients with lower health status being at risk for drop-out. No variables measured significantly predicted who those at risk would be for non-response to rehabilitation, p > .05. Pulmonary function data did not predict drop-out or non-response to PR. These findings indicate that perceived impairment (i.e., health status) is more likely to influence completion of rehabilitation than actual pulmonary impairment and that demographic and standard clinical data do not adequately predict patient drop-out and non-response to rehabilitation.

Distinguishing Perceived Competence and Self-Efficacy: An Example From Exercise

This article examined the conceptual and statistical distinction between perceived competence and self-efficacy. Although they are frequently used interchangeably, it is possible that distinguishing them might assist researchers in better understanding their roles in developing enduring adaptive behavior patterns. Perceived competence is conceived in the theoretical framework of self-determination theory and self-efficacy is conceived in the theoretical framework of social-cognitive theory. Purpose: The purpose of this study was to empirically distinguish perceived competence from self-efficacy for exercise. Method: Two studies evaluated the independence of perceived competence and self-efficacy in the context of exercise. Using 2 extant instruments with validity and reliability evidence in exercise contexts, the distinctiveness of the 2 constructs was assessed in 2 separate samples (n = 357 middle-aged sedentary adults; n = 247 undergraduate students). Results: Confirmatory factor analysis supported the conceptual and empirical distinction of the 2 constructs. Conclusions: This study supports the conceptual and statistical distinction of perceived competence from perceived self-efficacy. Applications of these results provide a rationale for more precise future theorizing regarding their respective roles in supporting initiation and maintenance of health behaviors.

Development and impact of exercise self-efficacy types during and after cardiac rehabilitation.

OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in the developed world. Cardiac rehabilitation (CR) is a comprehensive treatment program centered on structured exercise that has been demonstrated to achieve significant decreases in mortality and morbidity in cardiac patients, yet few patients adhere to exercise post-CR and so fail to maintain any health benefits accrued during rehabilitation. One reason for the lack of adherence might be that CR fails to address the challenges to adherence faced by patients when they no longer have the resources and structure of CR to support them. Self-efficacy (SE) is a robust predictor of behavioral persistence. This study therefore focuses on changes in different types of SE during CR and the relationship of SE to subsequent levels of physical activity. METHOD A sample of 63 CR patients completed assessments of task, scheduling and coping SE at baseline and the end of CR, as well as self-reported exercise behavior at the end of CR and 1-month post-CR. RESULTS Task SE (for performing elemental aspects of the behavior) was found to be most changed type of SE during CR and was strongly related to self-reported exercise at the end of CR. However, scheduling SE (for performing the behavior regularly) was most strongly related to self-reported exercise post-CR. CONCLUSIONS These results are theoretically consistent and suggest that scheduling SE should be targeted during CR to improve post-CR exercise adherence.

Peer educator vs. respiratory therapist support: Which form of support better maintains health and functional outcomes following pulmonary rehabilitation?

OBJECTIVE This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. METHODS Phase one (n=79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n=168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. Georges Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. RESULTS Six-month follow-up data for phase one was collected for 66 COPD patients (n=35 peer support, n=31 UC) and 142 for phase two (n=42 peer support, n=52 RT support, n=48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. CONCLUSION Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. PRACTICE IMPLICATIONS There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide.

Influence of Performance Enhancement and Administrative Tasks on Coaches’ Stress and Intentions to Continue

The purposes of this study were to, (a) assess motivational experiences of performance enhancement tasks (PET) and administrative tasks (AT), and; (b) examine the relationships of emergent motivational experiences of each task type to coaches’ perceived stress and intentions to continue coaching. In total, 572 coaches completed an online survey, which assessed autonomy, competence, relatedness, and other characteristics of PET and AT, intentions to continue coaching, and perceived stress. Two separate exploratory factor analyses (EFA) were conducted, one for AT and one for PET. This was followed up with confirmatory factor analysis (CFA) and SEM to examine relationships between emerging factors and stress and intentions. The factors generated for PET reflected ideas of autonomy, time conflict, and satisfaction, and for AT also included competence, effort, and job requirements. The resulting experiences of AT and PET appear to have different influences on stress and intentions, suggesting their distinction...