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Title: A theory-based approach to the facilitation of patient adherence to pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease
Author: Grant, A. R.
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2007
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Objectives: Development of a specification for a theory-based intervention to facilitate long-term patient adherence to PR for COPD, and development of a specification for a future definitive Randomised Controlled Trial (RCT) of this intervention. Methods: Five independent yet interrelated studies comprising Stage-One of an integrated two-stage Health Technology Assessment Programme using the organising structure of the UK Medical Research Council Framework for Development and Evaluation of RCTs for Complex Interventions to Improve Health: 1 (Secondary Research): Bibliometric analysis and development of a literature search model for studies of patient adherence in electronic databases; 2 (Secondary Research): A methodological analysis of treatment fidelity in the 23 RCTs included in the Cochrane Review of PR for COPD; 3 (Secondary Research): A systematic review of 4 RCTs of interventions to facilitate adherence to PR for COPD; 4 (Primary Research): A cohort study utilising the Theory of Planned Behaviour to explore, measure and ultimately predict differences in walking exercise adherence between one PR cohort that received 12-months of ongoing ‘maintenance’ PR within a multi-centre surgical RCT and another standard-care PR cohort that did not receive ‘maintenance’ PR; and 5 (Primary Research): A randomised experiment of ‘medication and appointment non-adherent’, ‘socially isolated’ and ‘current smoker’ patient stereotypes on 389 health professionals’ and student health professionals’ estimates of patient adherence to PR for COPD. Conclusion: The Programme objectives were not achieved due to the lack of knowledge and understanding regarding the two fundamental concepts of adherence definition and measurement. Two key underpinning recommendations: i) a methodological review of adherence definition and measurement and ii) a systematic review of the relationship between adherence and treatment outcome are specified.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available