Evaluation of self-efficacy for self-management and the self-management behavior of COPD patients after completing an outpatient pulmonary rehabilitation program

Purpose: The purpose of this study was to assess self-efficacy for self-management behaviors and the self-management behaviors related to living with chronic obstructive pulmonary disease (COPD) in persons with moderate to severe COPD who have completed the Immanuel Medical Center Outpatient Pulmonary Rehabilitation program in Omaha, Nebraska (IMCOPPR), compared with patients who received standard office education and advice during their physician visits.

Method: Participants were surveyed about their self-efficacy for self-management behaviors and their practice of self-management behaviors as they pertain to living with COPD. One group consisted of people who had completed the IMCOPPR program within the last 24 months. The participants in the intervention group were taught behaviors that are needed to successfully manage COPD. The comparison group consisted of people with comparable severity of COPD, who had not completed a pulmonary rehabilitation program. There were 30 subjects in each group. There were 14 self-efficacy and 14 self-management behaviors evaluated such as the practice of pursed-lip breathing and talking to the doctor when medications are not effective.

Findings: Self-efficacy behavior as a whole was found to be significantly better for the intervention group. This group was also significantly better than the comparison group in six of the self-efficacy variables and five of the self-management variables.

Conclusion: These findings are encouraging for the effectiveness of the IMCOPP in helping persons with COPD manage their disease especially for the self-efficacy behaviors of: not smoking, practicing pursed-lip breathing, talking with someone when sad, telling the doctor when medicines are not working, exercising regularly, and use of quick relief medicines before exercise, and the self-management behaviors of: slowing the pace to enjoy social activities, the practice of pursed-lip breathing, talking with someone when sad, telling the doctor when medicines are not working, and exercising regularly, but cannot be generalized to all pulmonary rehabilitation programs. Further research that evaluates the behaviors that are needed to live with COPD should concentrate on focusing on specific actions within the behavior variable like asking about the exact symptoms of worsening COPD and the self-management behavior that is enacted to determine if additional significant improvements can be seen in the IMCOPPR group. Such improvements should also be studied to see if they are related to better health outcomes like health-related quality of life and a decrease in healthcare utilization (emergency room visits or unscheduled physician visits) for participants of this program.