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Title: Self-management education in pulmonary rehabilitation for patients with COPD
Author: Gana-Inatimi, Joy
ISNI:       0000 0004 7656 6959
Awarding Body: University of Central Lancashire
Current Institution: University of Central Lancashire
Date of Award: 2017
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Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD). Self-management is an evolving and under-researched area within PR. The aim of this thesis was to explore the impact of self-management on health outcomes in patients with COPD. Methods and Results: The thesis was comprised of four studies. In a survey, all 27 PR programmes in North West England included self-management education, but there were differences in who delivered this component and the content and delivery formats. An interrogation of a clinical database to explore the relationship between COPD self-management, measured using the Bristol COPD Knowledge Questionnaire (BCKQ), with functional capacity, respiratory disability and emotional functioning demonstrated an improvement post PR intervention in all measures but there was no relationship found between the BCKQ and the other health outcomes, in 825 COPD patients attending one PR programme. This raised the possibility about the appropriateness of the selfmanagement strategy in this PR service and the relevance of the self-management measure used. A literature review using systematic methods identified 13 randomised controlled trials investigating the impact of self-management in COPD (none in PR). The self-management strategies used were consistent with the PR service in the above study but suggested that other measures might be more appropriate to estimate selfmanagement. Therefore, 266 patients were asked to complete the BCKQ, Understanding COPD (UCOPD) questionnaire and the Chronic Disease Self-Efficacy (CDSES) questionnaire at the start and end of PR. This showed all measures of selfmanagement improved with PR self-management intervention (BCKQ 27.7%, UCOPD 45.2%, CDSES 30.9%), there was a relationship between the UCOPD and CDSES but except for emotion and the CDSES, there was no relationship between the UCOPD and CDSES and the other clinical measures post intervention. Conclusion: The findings confirm that there is a lack of a supporting evidence base to inform guidelines for clinical practice on self-management in PR, particularly how to optimise health outcomes through self-management strategies. Further research is needed on which measures of self-management are appropriate for evaluating this component of PR.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: A300 - Clinical medicine