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Exploration of the feasibility to combine patients with chronic obstructive pulmonary disease and chronic heart failure in self-management groups with focus on exercise self-efficacy
Örebro University, School of Medical Sciences. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.ORCID iD: 0000-0001-6261-6925
Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
Örebro University, School of Health Sciences. Örebro University Hospital.ORCID iD: 0000-0002-8370-8834
Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-1926-8464
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2022 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 2, p. 208-216Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare the level of exercise self-efficacy, symptoms, functional capacity and health status and investigate the association between these variables in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Additionally, to investigate how diagnosis, symptoms and patient characteristics are associated with exercise self-efficacy in these patient groups.

DESIGN: Cross-sectional study.

SETTING: Primary care.

SUBJECTS: Patients (n = 150) with COPD (n = 60), CHF (n = 60) and a double diagnosis (n = 30).

MAIN OUTCOME MEASURES: Swedish SCI Exercise Self-Efficacy score, modified Medical Research Council Dyspnea score (mMRC), fatigue score, pain severity score, Hospital Anxiety and Depression Scale, functional capacity measured as six-minute walking distance and health status measured by a Visual Analogue Scale.

RESULTS: Levels of exercise self-efficacy, health status and symptoms were alike for patients with COPD and patients with CHF. Functional capacity was similar after correction for age. Associations with exercise self-efficacy were found for slight dyspnea (mMRC = 1) (R -4.45; 95% CI -8.41- -0.50), moderate dyspnea (mMRC = 2) (-6.60;-10.68- -2.52), severe dyspnea (mMRC ≥ 3) (-9.94; -15.07- -4.80), fatigue (-0.87;-1.41- -0.32), moderate pain (-3.87;-7.52- -0.21) and severe pain (-5.32;-10.13- -0.52), symptoms of depression (-0.98;-1.42- -0.55) and anxiety (-0.65;-0,10- -0.32), after adjustment for diagnosis, sex and age.

CONCLUSION AND IMPLICATIONS: Patients with COPD or CHF have similar levels of exercise self-efficacy, symptoms, functional capacity and health status. More severe symptoms are associated with lower levels of exercise self-efficacy regardless of diagnosis, sex and age. When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider level of symptoms than the specific diagnosis of COPD or CHF.Key pointsExercise training is an important part of self-management in patients with COPD and chronic heart failure (CHF). High exercise self-efficacy is required for optimal exercise training.Patients with COPD and CHF have similar symptoms and similar levels of exercise self-efficacy, functional capacity and health status.Not the diagnosis, but symptoms of dyspnea, fatigue, pain, depression and anxiety are important factors influencing exercise self-efficacy and need to be addressed.When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider the level of symptoms than the specific diagnosis of COPD or CHF.

Place, publisher, year, edition, pages
Taylor & Francis, 2022. Vol. 40, no 2, p. 208-216
Keywords [en]
Pulmonary disease, chronic obstructive, exercise, feasibility studies, heart failure, self-efficacy, self-management
National Category
Respiratory Medicine and Allergy Physiotherapy
Identifiers
URN: urn:nbn:se:oru:diva-99025DOI: 10.1080/02813432.2022.2073961ISI: 000799416300001PubMedID: 35575429Scopus ID: 2-s2.0-85130564713OAI: oai:DiVA.org:oru-99025DiVA, id: diva2:1658606
Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2024-01-03Bibliographically approved
In thesis
1. Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
Open this publication in new window or tab >>Management of chronic obstructive pulmonary disease and chronic heart disease in primary health care: Guidelines, patients and comorbidity
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this compilation thesis was to explore different aspects of the management of patients with chronic obstructive pulmonary disease (COPD) and heart disease in primary health care: guideline adherence in chronic heart failure (CHF) management (I); comparing patients with COPD and heart failure, and factors associated with the pa-tients’ exercise self-efficacy (II); and the influence of comorbid heart disease in COPD over time (III–IV).

Materials and methods: Cross-sectional data from primary health care: 155 patients with heart failure (I) and 150 with COPD and/or heart failure (II). Longitudinal data from patients with COPD from 2005 through 2012 (III) and 2019 (IV), based on questionnaires, medical records, and national registers.

Results: (I) Over 80% of the heart failure patients had received relevant laboratory tests and echocardiography. Recommended medication was given to most of the patients, but only a few achieved target doses. Contact with a hospital heart failure clinic was associated with better self-care behavior. (II) Patients with COPD or heart failure had similar exercise self-efficacy, symptoms, functional capacity, and health status. Exercise self-efficacy was associated with symptoms, but not with the diag-nosed disease. (III) COPD with comorbid heart disease was associated with a lower health status and higher level of dyspnea but did not accelerate the worsening over time. (IV) Comorbid heart disease was associated with increased hospitalization and mortality, not for respiratory disease, but mainly for cardiovascular and other causes.

Conclusions: Adherence to guidelines for CHF in primary health care is suboptimal, particularly regarding medication target dosage and patient education. It seems more relevant to consider the symptom level than the specific diagnosis when forming self-management groups to increase exercise self-efficacy. In COPD management in primary health care, it is important to recognize and treat heart disease.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2022. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 269
Keywords
COPD, chronic heart failure, heart disease, patient outcomes, exercise self-efficacy, comorbidity, primary health care, cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-101233 (URN)9789175294681 (ISBN)
Public defence
2022-11-11, Samlingssalen, Centralsjukhuset i Karlstad, Rosenborgsgatan 9, Karlstad, 13:15 (English)
Opponent
Supervisors
Available from: 2022-09-14 Created: 2022-09-14 Last updated: 2024-01-03Bibliographically approved

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Giezeman, MaaikeZakrisson, Ann-BrittSundh, JosefinHasselgren, Mikael

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