Five-year follow-up of a one-year self-management program for patients with COPD.

OBJECTIVE: Investigate long-term effects 4 years after the end of a 1-year self-management program (SMP) with 30 hours of education and 16 hours of physical activity in patients with chronic obstructive pulmonary disease (COPD). METHODS: Prospective observational outcome study. SMP focused on improving disease related self-care skills. Main outcome measures were health-related quality of life, HRQoL, (St Georges Respiratory Questionnaire, SGRQ total) and exercise capacity (6-minute walk test, 6MWT). RESULTS: Thirty patients participated, 47% women. Baseline mean age was 67 years and mean pre-bronchodilator FEV(1) (forced expiratory volume in 1 second) percentage predicted was 41.3. HRQoL showed a statistical significant improvement during the 1-year intervention. Four years after the end of the program SGRQ total was similar to baseline value, 1.4 points (95% CI: -3.6 to 6.3, P = 0.580). Also 6MWT was similar to baseline value at the same test point, -10 m (95% CI: -27 to 8, P = 0.262), and 63% reported having continued to exercise regularly a minimum of three times per week during the follow-up period. CONCLUSION: The participants in a 1-year self-management program with additional training had maintained their pre-intervention level of HRQoL and exercise capacity 4 years after the end of the program. Two out of three participants had continued to exercise regularly.

Coping with arthritis is experienced as a dynamic balancing process. A qualitative study.

The aim of this study was to investigate the process of coping in people living with chronic inflammatory arthritis. Semi-structured individual face-to-face interviews with 26 persons having rheumatoid arthritis, psoriatic arthritis or unspecified polyarthritis were performed. The informants were asked how they experienced to live with arthritis and how they coped with challenges due to the arthritis. The main finding was that the informants experienced the process of coping with arthritis as a dynamic, iterative, balancing process. They balanced between different states, entitled "go on as usual", "listen to the body", "adjustments" and "attitude towards life". The informants preferred to be in a "go on as usual" state as this was seen as normal life. However, disease fluctuations with pain, fatigue and stiffness disturbed the balance and made the informants "listen to the body", a state where they became aware of how the disease affected them, followed by the "adjustment" state. Adjustments were composed of different efforts to ease the arthritis influence and for regaining balance. The "attitude towards life" influenced the overall process of coping. A redefined view of what the informants considered to be normal life thus happened through longer periods of imbalance. The process of coping with arthritis was found to be a dynamic, iterative, balancing process where patients redefined what they considered as normal life through the course of the disease.

Reasons for participation in group-based type 2 diabetes self-management education. A qualitative study.

AIMS: To investigate reasons for participating in group-based diabetes self-management education (DSME) for patients with type 2 diabetes. METHODS: A qualitative study using focus groups and individual semi-structured interviews was conducted with 22 patients attending seven different groups in Central Norway. RESULTS: Patients with diabetes described two main reasons for attending DSME; experiencing practical problems and feeling insecure. These reasons differed by affecting the patients in two ways - practically or emotionally. Practical problems and feeling insecure both originated from lack of or contradictory information and from lack of contact with other patients with diabetes. This affected the patients' everyday lives in important areas such as diet, medication, social settings and lifestyle changes. CONCLUSIONS: The underlying reason for participating in a DSME was the participants' experience of having insufficient information about their diabetes, which led to practical problems and emotional insecurity. Being aware of the patients' reasons for participating can help professionals keep a focus which is more consistent with patients' needs.

Observational studies of a one year self-management program and a two year pulmonary rehabilitation program in patients with COPD.

OBJECTIVE: To describe the outcome of a one year self-management program (SMG) and a two year pulmonary rehabilitation program (PRG). METHODS: Two open prospective observational studies with 30 patients in each study. SMG had 46 hours over 12 months. PRG had in addition three weekly exercise sessions parallel which lasted an additional year. RESULTS: In SMG, health-related quality of life (HRQoL, measured by St. George's Respiratory Questionnaire) had an improvement of-3.6 points (95% CI -6.7 to -0.5) one year after the end of the intervention, but there was no change in the six minutes walking test (6MWT). The PRG had an improvement in HRQoL at the end of the intervention of -11.2 points (95% CI -13.9 to -8.4) and the 6MWT was clinically significant improved with 86 metres (95% CI 63 to 109). None of the groups showed any clinical relevant change in lung function. CONCLUSION: Participants in the SMG had had an improvement in quality of life and no deterioration in exercise tolerance one year after the end of the program compared to the start. Participants in the PRG significantly improved their quality of life and exercise tolerance the first year, but had no further clinical relevant improvement the second year.