Association Between Self-care and Resilience: A Cross-sectional Study in Heart Failure Patients.

BACKGROUND: Self-care (SC) is a cornerstone in heart failure management and is related to patient outcomes. The continuous and complex demands of SC can be experienced as stressful and may require patients to apply resilient behaviors as they manage their conditions. Resilience may be a helpful factor in performing SC. OBJECTIVE: The aim of this study was to determine the association between resilience and SC in patients with heart failure. METHODS: A cross-sectional study was performed between January 2020 and January 2021. Participants were asked to complete a questionnaire addressing baseline characteristics, the 2-item Patient Health Questionnaire, the Resilience Evaluation Scale, and the Self-Care of Chronic Illness Inventory, which measures 3 concepts of SC: SC maintenance, SC monitoring, and SC management. Multiple regression analysis was performed to determine whether resilience was associated with SC. RESULTS: Eighty-six patients were included, and 74 patients completed the questionnaire. In the univariate analysis, an association was found between resilience and SC maintenance, resulting in an increase in SC for patients with higher resilience (ß = 0.24; 95% confidence interval, 0.03-0.96). In the multivariate analysis adjusted and corrected for confounders, no significant associations between resilience and all SC scales were found. CONCLUSION: This study could not demonstrate significant associations between resilience and all SC scales. This study contributes to the body of knowledge on factors that can mediate or moderate SC. Further longitudinal research should be performed to study cause-effect relationships.

The use of virtual reality in patient education related to medical somatic treatment: A scoping review.

OBJECTIVE: To map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment. METHODS: A Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms 'Virtual Reality' and 'Patient Education'. The literature was synthesised and mapped with a narrative approach. RESULTS: 17 studies published between 2015 and 2020 were included in the qualitative synthesis. VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance. CONCLUSIONS: The application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment. Practice implications It is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.

Patients' voices in the development of pre-surgical patient education using virtual reality: A qualitative study.

Objective: To identify the information needs and perceptions of patients regarding the application of virtual reality in pre-surgical patient education. Methods: A qualitative study was conducted between March and July 2020. The study population consisted of a purposive sample of patients scheduled for cardiac surgery from a single institution. Semi-structured individual interviews (n=19) were conducted and analysed using thematic analysis. Results: Patient perceptions regarding virtual reality and information needs related to hospitalisation and surgery could be categorised into three themes: Creating familiarity, contents to explore and challenges and preconditions. Conclusions: Virtual reality technology is a promising tool that can enhance conventional patient education to improve understanding and to potentially reduce concerns and anxieties. The virtual reality environment creates an opportunity for patients to be in control of the timing, quantity, depth and frequency of patient education. A virtual reality education tool should not be a substitute for personal contact with the physician. Innovation: Patient information needs were identified profoundly to the further development of a virtual reality intervention. This intervention aims to educate patients prior to elective cardiac surgery.

Patients' perspectives on the COPD-GRIP intervention, a new nursing care intervention for COPD.

BACKGROUND: The nurse-led chronic obstructive pulmonary disease-Guidance Research on Illness Perception (COPD-GRIP) intervention was developed to incorporate illness perceptions into COPD care with the intention to improve the health-related quality of life of COPD patients. This individualized intervention focuses on identifying, discussing and evaluating illness perceptions and consists of three consultations with a practice nurse. The aim of this study is to explore patients' experiences regarding the COPD-GRIP intervention. METHODS: A qualitative interview study nested in a cluster randomized trial in primary care. One-time semi-structured individual interviews with COPD patients who were guided with the COPD-GRIP intervention were conducted. During data collection, the constant comparative approach was used. All interviews were recorded, transcribed, anonymized and uploaded to MAXQDA. To identify themes, the transcripts were independently coded by two researchers. RESULTS: Sixteen patients were interviewed. All patients were positive and experienced an additional value of the COPD-GRIP intervention in different areas. Three main themes were identified and show that taking part in this intervention made the patients feel 'listened to and acknowledged', improved their awareness of the disease and its management and helped them to make lifestyle changes. Some patients suggested that the individualized care plan could be improved and to start the intervention immediately after being informed of the COPD diagnosis. All patients recommended this intervention. CONCLUSION: The results of this study indicate that patients acknowledge that the COPD-GRIP intervention is a useful and promising tool for providing individualized COPD care.

The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care.

The new COPD-GRIP (Chronic Obstructive Pulmonary Disease - Guidance, Research on Illness Perception) intervention translates evidence regarding illness perceptions and health-related quality of life (HRQoL) into a nurse intervention to guide COPD patients and to improve health outcomes. It describes how to assess and discuss illness perceptions in a structured way. This study aimed to assess the effectiveness of the intervention in primary care. A cluster randomised controlled trial was conducted within 30 general practices and five home-care centres, including 204 COPD patients. 103 patients were randomly assigned to the intervention group and 101 patients to the usual-care group. To assess differences, repeated multilevel linear mixed modelling analyses were used. Primary outcome was change in health status on the Clinical COPD Questionnaire (CCQ) at 9 months. Secondary outcomes were HRQoL, daily activities, health education impact and changes in illness perceptions. There was no significant difference between the groups in the CCQ at 9 months. We found a significant increase in health-directed behaviour at 6 weeks (p=0.024) and in personal control (p=0.005) at 9 months in favour of the intervention group. The COPD-GRIP intervention, practised by nurses, did not improve health status in COPD patients in primary care. However, the intervention has benefits in improving the ability to control the disease and health-related behaviours in the short term. Therefore, taking illness perceptions into account when stimulating healthy behaviours in COPD patients should be considered. Further study on influencing the health status and HRQoL is needed.

Nurses' perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study.

BACKGROUND: The major challenges in Chronic Obstructive Pulmonary Disease (COPD) care are guiding a patient in daily living with the consequences of the disease, reducing the impact of symptoms and improving Health Related Quality of Life (HRQoL). The new nurse-led COPD-Guidance, Research on an Illness Perception (COPD-GRIP) intervention translates the evidence concerning illness perceptions and Health Related Quality of Life (HRQoL) into a practice nurse intervention. The aim is to explore the nurses' experiences with applying the new COPD-GRIP intervention. METHOD: An explanatory mixed-method study nested in a cluster randomized trial in primary care was conducted. Pre-intervention questionnaires were sent to all participating nurses (N=24) to identify expectations. Post-intervention questionnaires identified experiences after applying the intervention followed by two focus groups to further extend exploration of findings. Questionnaires were analyzed by descriptive analyses. To identify themes the audio-taped and transcribed focus groups were independently coded by two researchers. RESULTS: The nurses described the intervention as a useful, structured and individualized tool to guide COPD patients in living with the consequences of COPD. Applying the intervention took less time than the nurses initially expected. The intervention enables to provide patient-centered care and to address patient needs. Barriers were encountered, especially in patients with a lower social economic status, in patients with a lower health literacy and in patients with other cultural backgrounds than the Dutch background. CONCLUSION: Nurses perceived the COPD-GRIP intervention as a feasible, individualized tool. According to the nurses, the intervention is a valuable improvement in the care for COPD patients.

The Dutch functional performance inventory: validity and reliability in patients with chronic obstructive lung disease.

BACKGROUND: Performing activities of daily living (ADLs) is an important outcome measure in chronic obstructive pulmonary disease (COPD). The functional performance inventory (FPI) can be used to measure ADL performance in people with COPD. OBJECTIVE: The aims are to report translation of the FPI into the Dutch language and evaluate the validity and reliability of the translated version in a Dutch COPD population. METHODS: The FPI was translated, after which validation and test-retest reliability studies were conducted. The Consensus-Based Standards for Selection of Health Status Measurement Instruments checklist was used. The Clinical COPD Questionnaire (CCQ), the self-administered Chronic Respiratory Questionnaire-Standardized, and the Medical Research Council Dyspnea Scale were used in the validation study. Test-retest reliability was estimated across 2 weeks in patients with stable COPD. RESULTS: Participants were patients with COPD from the Netherlands who took part in either the validation (n = 90) or reliability study (n = 60). The validity analyses showed that, as hypothesized, the household maintenance and physical exercise subscales of the Dutch version of the FPI had high correlations with the CCQ functional status domain; the total FPI had a correlation of -.44, with CCQ functional status domain. Across the subscales, score reliability estimated with Cronbach's alpha ranged from .55 (Body Care) to .97 (Household Maintenance); total score alpha was .98. Intraclass correlations (ICCs) ranged from .84 (Social Activities) to .97 (Body Care and Household Maintenance); total scale ICC was .98. Recreation and Spiritual Activity subscales varied significantly on retesting at 2 weeks. DISCUSSION: Scores on the Dutch FPI were reliable and reproducible. Evidence for validity was reasonable, but less strong than that reported in studies from other populations.

Perceived quality of life in chronic obstructive pulmonary disease patients: a cross-sectional study in primary care on the role of illness perceptions.

BACKGROUND: Previous research has shown that in Chronic Obstructive Pulmonary Disease (COPD) patients, it is important to consider not only physical functioning and complaints but also psychological factors, such as illness perceptions, to explain differences in Health-Related Quality of Life (HRQoL). The objective of this study is to analyse the extent to which the specific dimensions of illness perceptions according to the Common Sense Model (corrected for airflow limitation, dyspnoea and comorbidities) contribute to HRQoL. METHOD: In a cross-sectional study in primary care, 90 COPD patients completed questionnaires: The Brief Illness Perception Questionnaire, the Medical Research Council dyspnoea scale, the Clinical COPD Questionnaire (CCQ) and the Chronic Respiratory Questionnaire (CRQ). Analyses were performed with multiple linear regression. RESULTS: When corrected for confounders (airflow limitation, dyspnoea and comorbidities), identity (ß = .42) and comprehensibility (ß = -.16) were associated with HRQoL (CCQ). Identity, comprehensibility and dyspnoea explained 56% of the variation in HRQoL (R2 = .56). Consequences (ß = -.50) and treatment control (ß = .20) were associated with HRQoL (the CRQ's physical domain). They explained 59% of the variation in the CRQ physical (R2 = .59) domain. Treatment control (ß = .19) and emotional response (ß = -.33) were associated with the CRQ emotional domain. CONCLUSIONS: Patients who experience fewer symptoms attributed to COPD, who have a better understanding of the disease, who experience less impact of COPD in daily life, who experience better treatment control and who have less of an emotional response have better HRQoL. This study indicates that the HRQoL of COPD patients is associated with illness perceptions as well as with the severity of dyspnoea as experienced by patients. Airflow limitation measures or comorbidities do not add to the explanation of HRQoL. The results of this study provide starting points for the development of interventions focusing on illness perceptions to support COPD patients in their disease management and to improve HRQoL.

Daily activities and health-related quality of life in patients with chronic obstructive pulmonary disease: psychological determinants: a cross-sectional study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients are confronted with reduced daily activities (DA) and reduced health-related quality of life (HRQoL) caused by dyspnea and systemic effects such as skeletal muscle dysfunction and co-morbidities. To understand the complexity of living with COPD, it is important to understand which factors, in addition to physical functioning, are associated with DA and HRQoL. In this study, we explored the extent to which the combination of illness perceptions, proactive coping, and depressive symptoms contribute to DA and HRQoL in COPD patients. METHOD: In a cross-sectional study in primary care, 90 COPD patients (GOLD I-III) completed questionnaires: the Brief Illness Perception Questionnaire, the Utrecht Proactive Coping Competence scale, the Centers for Epidemiologic Studies Depression scale, the Medical Research Council dyspnea scale, the Functional Performance Inventory (FPI), and the Clinical COPD Questionnaire (CCQ). The analyses were performed with multiple linear regression analyses. RESULTS: More adequate and positive illness perceptions (ß = .61, p < .001) and less depressive symptoms (ß = .21, p = .010) were associated with better HRQoL (CCQ). Significant relations between psychological factors and DA were not found. CONCLUSION: The results of this study demonstrate that psychological factors are related to HRQoL, but not to DA. These results contribute to understanding the complexity of living with COPD and provide starting points for the development of interventions focusing on psychological factors to support COPD patients in disease management.

Evaluation of Quality of Life instruments for use in COPD care and research: a systematic review.

OBJECTIVE: Quality of Life (QoL) measurements to quantify disease burden have become an important outcome measure in Chronic Obstructive Pulmonary Disease (COPD) research and treatment. A large variety of QoL instruments is available. The objective of this review was to comprehensively evaluate content and psychometric properties of available QoL instruments used in COPD care and research. DESIGN: A systematic literature search was performed. DATABASES: The databases PubMed, Embase, CINAHL, and the Cochrane Library were used. REVIEW METHOD: Two researchers independently identified eligible studies. Methodological quality of the studies and data on measurement properties were assessed by using the Consensus based Standards for selection of health Measurement Instruments (COSMIN). A best evidence synthesis for each instrument was performed. RESULTS: 77 studies describing 13 disease-specific and 10 generic QoL instruments were identified. The content of the instruments showed a great variety. 20 instruments measured mobility. Pulmonary symptoms were measured in 11 disease specific instruments. Pain, vitality, and spiritual activities were domains seen only in generic instruments. Social and emotional functioning were domains seen in disease specific instruments as well as in generic instruments. The methodological quality of the studies was mostly rated fair, according to the COSMIN checklist. The psychometric properties of the instruments (validity, reliability and responsiveness) were in general rated positive. The best evidence synthesis showed the strongest positive evidence for the disease specific instruments Chronic Respiratory Questionnaire (CRQ), COPD Assessment Test (CAT), Saint George Respiratory Questionnaire (SGRQ), and Living with COPD questionnaire (LCOPD). The generic instruments received less favorable ratings. CONCLUSION: Despite the comprehensive overview we could not uniformly recommend the best instrument to evaluate QoL in COPD patients. However, we could recommend the disease specific instruments CRQ, CAT, SGRQ, or LCOPD. In addition to the best evidence synthesis, the decision to use one instrument over another, will be driven by study purpose and research questions in combination with the domains of the instrument. Given the large availability of instruments we discourage to develop new instruments, instead we encourage to design studies according the COSMIN standards to evaluate the psychometric properties of the existing instruments.