Chest
Volume 140, Issue 6, December 2011, Pages 1534-1539
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Original Research
COPD
Measuring a Change in Self-Efficacy Following Pulmonary Rehabilitation: An Evaluation of the PRAISE Tool

https://doi.org/10.1378/chest.10-2649Get rights and content

Background

Self-efficacy explores the emotional functioning and coping skills of an individual and is thought to be a strong predictor of health behaviors, which is particularly important for pulmonary rehabilitation (PR). However, to our knowledge, there is no measure of self-efficacy developed to explore behavior change in the context of PR.

Methods

We investigated the reproducibility and sensitivity of Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE): a tool adapted from the General Self-Efficacy Scale (GSES) to measure the dimension of self-efficacy at the time of a course of PR. Twenty-nine clinically stable patients with COPD completed PRAISE on their initial assessment to PR. The tool was then completed 7 days later. An additional 225 patients completed PRAISE prior to, and on completion of a 7-week course of PR. In addition, exercise capacity was measured by the incremental shuttle walk test (ISWT), with the Medical Research Council (MRC) dyspnea scale, Chronic Respiratory Questionnaire-Self Reported (CRQ-SR), and Hospital Anxiety and Depression Scale (HADS) also being collected. This process was repeated postrehabilitation. Data were then analyzed to investigate the possibility that PRAISE could be an indicator of PR response.

Results

In the reproducibility study, the mean change in score was 0.72 (95% CI, −2.27-0.82), examined with intraclass correlation coefficients, r = 0.99; indicating PRAISE test-retest reproducibility. The mean change of score in the sensitivity study pre- to post-PR was 3.59 (95% CI, 2.24-4.73; P = .015). Change in the ISWT was 83.44 m (95% CI, 54.0-112.8; P < .0001). There were several statistically significant differences between variables, particularly with the mastery and emotion elements of the CRQ-SR at baseline, but this was lost post-PR. This observation was also found with HADS. No significant differences were found between MRC dypsnea scale grades with the change in PRAISE score. PRAISE could not predict a successful outcome of PR.

Conclusions

The PRAISE tool is a reliable and sensitive measure of self-efficacy for patients with COPD attending PR.

Section snippets

Pulmonary Rehabilitation Adapted Index of Self-Efficacy

We adapted the General Self-Efficacy Scale (GSES) specifically for the population of patients in PR. The original tool is a validated 10-item scale.11 Currently, the original scale has been translated into 26 languages. It measures generalized perceived self-efficacy at any given time and has been reported extensively in the literature. Typical items are “Thanks to my resourcefulness, I know how to handle unforeseen situations” and “When I am confronted with a problem, I can usually find

Reliability Study

The mean change in score was 0.72 (95% CI, −2.27-0.89; P = .34). The intraclass correlation coefficient was r = 0.99 (P ≤ .001). A Cronbach α was calculated on all items of the scale (0.95). A Bland and Altman plot is also provided in e-Figure 1.

Sensitivity Study

The mean change of 3.59 in PRAISE score was statistically significant (P = .015). The mean change in the ISWT was 83.44 m (P < .0005). The 38 patients who dropped out from the study did score lower overall before PR in ISWT, CRQ-SR, HADS, and PRAISE,

Discussion

This article describes the development and testing of a self-efficacy scale specifically for use in PR. There is no other tool currently available. The GSES adapted for PR, PRAISE, demonstrates test-retest reliability and internal consistency. PRAISE is also sensitive to change, enabling us to document an improvement in the patient's level of self-efficacy after a course of PR. This correlates with previous research findings suggesting that PR may have a direct effect upon specific

Conclusions

This study indicates that PRAISE is both reproducible and sensitive in this population, although it is unable to determine those patients who may drop out of PR. PRAISE is sensitive to change in PR patients, easy to use, and well tolerated. PRAISE can, therefore, be proposed as a practical instrument that explores a different psychologic dimension for those patients attending PR.

Acknowledgments

Author contributions: Ms Vincent: conceived the original idea, developed the protocol, completed the analysis, and wrote the manuscript.

Dr Sewell: completed analysis and approved the manuscript.

Ms Wagg: completed analysis and approved the manuscript.

Dr Deacon: supported data collection and approved the manuscript.

Ms Williams: completed analysis and approved the manuscript.

Dr Singh: developed the protocol, gave overall supervision, and revised the manuscript for intellectual content.

References (19)

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Funding/Support: This study was supported by a project grant from the British Lung Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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