Effect of counselling during pulmonary rehabilitation on self-determined motivation towards physical activity in people with chronic obstructive pulmonary disease – protocol of a mixed methods study
Abstract:BackgroundPhysical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD.MethodsA two-armed, single blind randomised controlled trial including 5… Show more
“…This qualitative study was nested in a randomized controlled trial that primarily investigated the effect of counselling, as part of a comprehensive outpatient PR for individuals with COPD, on PA. 32 , 33 The study was registered on the website of https://www.clinicaltrials.gov/ with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015). Qualitative methods were chosen to analyze and differentiate “types” of patients, based on perception of PA and motivation towards behavioral change in PA in daily life.…”
Section: Methodsmentioning
confidence: 99%
“…Exclusion criteria were applied as previously described briefly summarized as mental or physical disability and severe uncontrolled co-morbidities. 33 Figure 1 Flowchart of the study. …”
Section: Methodsmentioning
confidence: 99%
“…A comprehensive PR 7 (named “PneumoReha”) was performed, which included education and an individually tailored exercise intervention, according to the study protocol. 33 For twelve weeks participants attended the outpatient clinic twice weekly (1.5-hour sessions) and received one session of supervised Nordic Walking training outdoors (1.5-hour session). Thus, a total of 36 physical training sessions were performed during the 12-week PR.…”
Section: Methodsmentioning
confidence: 99%
“…Exclusion criteria were applied as previously described briefly summarized as mental or physical disability and severe uncontrolled co-morbidities. 33 Of the 43 patients enrolled, 22 were invited to participate in the interviews, of whom four declined. The reasons for declining were "no consent to audiotaping", "lack of time", "no interest" and "forthcoming operation".…”
Objective
The aim of this study was to explore to what extent a combined counselling and pulmonary rehabilitation program (PR) influences the perception of physical activity (PA) and motivation for behavioral change in PA in individuals with COPD. The results of previous quantitative trial that investigated the effect of this combined treatment on daily PA were inconclusive. It is conjectured that a more targeted tailoring of the counselling and PR intervention could improve its effectiveness.
Patients and Methods
Eighteen individuals with COPD (median age 69, 8 females) who had participated in the PneumoReha program were interviewed twice (following PR and at three-month follow-up). These interviews were transcribed and analyzed thematically. Based on the codes thus identified, three categories ‘perception of PA intensity’, ‘quality of motivation to perform PA’, and ‘strategies to cope with barriers’ were used to differentiate ‘types’ of participants.
Results
Four different types of COPD individuals were distinguished. Study findings indicate that those individuals who participated in the PR program combined with embedded counselling tended to be more active and intrinsically motivated.
Conclusion
A typology of four types of people with COPD was developed, characterized by their perception of activity, individual motivation and strategies for managing barriers. The patients’ physical activity level might be influenced by their concept of physical activity and the quality of motivation. Recognizing patients’ different activity behaviors is important for improving the quality of outpatient PR programs and developing tailored (according to each type) counselling interventions embedded in outpatient PR programs.
Clinical Trial Registration
The study was registered on the website of
https://www.clinicaltrials.gov/
with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015).
“…This qualitative study was nested in a randomized controlled trial that primarily investigated the effect of counselling, as part of a comprehensive outpatient PR for individuals with COPD, on PA. 32 , 33 The study was registered on the website of https://www.clinicaltrials.gov/ with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015). Qualitative methods were chosen to analyze and differentiate “types” of patients, based on perception of PA and motivation towards behavioral change in PA in daily life.…”
Section: Methodsmentioning
confidence: 99%
“…Exclusion criteria were applied as previously described briefly summarized as mental or physical disability and severe uncontrolled co-morbidities. 33 Figure 1 Flowchart of the study. …”
Section: Methodsmentioning
confidence: 99%
“…A comprehensive PR 7 (named “PneumoReha”) was performed, which included education and an individually tailored exercise intervention, according to the study protocol. 33 For twelve weeks participants attended the outpatient clinic twice weekly (1.5-hour sessions) and received one session of supervised Nordic Walking training outdoors (1.5-hour session). Thus, a total of 36 physical training sessions were performed during the 12-week PR.…”
Section: Methodsmentioning
confidence: 99%
“…Exclusion criteria were applied as previously described briefly summarized as mental or physical disability and severe uncontrolled co-morbidities. 33 Of the 43 patients enrolled, 22 were invited to participate in the interviews, of whom four declined. The reasons for declining were "no consent to audiotaping", "lack of time", "no interest" and "forthcoming operation".…”
Objective
The aim of this study was to explore to what extent a combined counselling and pulmonary rehabilitation program (PR) influences the perception of physical activity (PA) and motivation for behavioral change in PA in individuals with COPD. The results of previous quantitative trial that investigated the effect of this combined treatment on daily PA were inconclusive. It is conjectured that a more targeted tailoring of the counselling and PR intervention could improve its effectiveness.
Patients and Methods
Eighteen individuals with COPD (median age 69, 8 females) who had participated in the PneumoReha program were interviewed twice (following PR and at three-month follow-up). These interviews were transcribed and analyzed thematically. Based on the codes thus identified, three categories ‘perception of PA intensity’, ‘quality of motivation to perform PA’, and ‘strategies to cope with barriers’ were used to differentiate ‘types’ of participants.
Results
Four different types of COPD individuals were distinguished. Study findings indicate that those individuals who participated in the PR program combined with embedded counselling tended to be more active and intrinsically motivated.
Conclusion
A typology of four types of people with COPD was developed, characterized by their perception of activity, individual motivation and strategies for managing barriers. The patients’ physical activity level might be influenced by their concept of physical activity and the quality of motivation. Recognizing patients’ different activity behaviors is important for improving the quality of outpatient PR programs and developing tailored (according to each type) counselling interventions embedded in outpatient PR programs.
Clinical Trial Registration
The study was registered on the website of
https://www.clinicaltrials.gov/
with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015).
“…The study was registered on the website of http://www.ClincalTrails.gov with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015). The study protocol was also published [ 31 ].…”
Background
Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA.
Methods
A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed.
Results
Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time.
Conclusions
In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed.
Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
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