Self-Efficacy, Depressive Symptoms, and Patients’ Expectations Predict Outcomes in Asthma

Mancuso, Carol A.; Rincon, Melina; McCulloch, Charles E.; Charlson, Mary E.

doi:10.1097/00005650-200112000-00008

Cited by 141 publications

(120 citation statements)

References 52 publications

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“…After adjusting for some confounding factors such as age, sex, and race of the participants, glucocorticoid use, and prior exacerbations, the heterogeneity among the studies was reduced (21,22,25). Substantial heterogeneity also existed in the outcome of ED visits because of asthma, and adjustment for confounding factors such as age, sex, race, years of education, smoking, asthma control, inhaled corticosteroid dose, and medication adherence resulted in a significant statistical difference for the relation between PD and ED visits because of asthma (10,12,20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Ten of these were eligible prospective cohort studies and were included in the analysis (10)(11)(12)(20)(21)(22)(23)(24)(25)(26). The flowchart for screening studies is shown in Figure 1.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…In the included studies, exposure to PD was ascertained according to one of eight psychometric tools (10,12,(21)(22)(23)(24)(25)(26), the International Classification of Diseases, 9th Revision, diagnosis of co-morbidities (21), or patient self-report (11). The eight psychometric tools used were all produced in the 1900s.…”

Section: Exposure To Psychological Dysfunction (Pd)mentioning

confidence: 99%

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Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Zhang

Zheng³

et al. 2016

J. Thorac. Dis.

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Background:The longitudinal associations between psychological dysfunction (PD) and asthma exacerbations (AE) have not been adequately addressed. This study aimed to systematically assess the influence of PD on AE, and to determine whether different PD affects AE differentially. P<0.001], presenting as hospitalizations (RR adj =1.22, 95% CI: 1.12-1.34, P<0.001), unscheduled doctor visits (RR =4.26, 95% CI: 2.52-7.19), and emergency department (ED) visits (RR adj =1.06, 95% CI: 1.01-1.10, P=0.009) because of asthma. Depression significantly increased the risk of AE (RR adj =1.07, 95% CI: 1.04-1.11, P<0.001), presenting as hospitalizations (RR adj =1.26, 95% CI: 1.07-1.49, P=0.007) and ED visits (RR adj =1.06, 95% CI: 1.02-1.11, P=0.007) because of asthma. Anxiety was only associated with an increased risk of AE in pregnant women (RR =1.05, 95% CI: 1.01-1.08), possibly due to the small amount of data available on anxiety. The influence of PD on AE was only significant when the PD exposure time exceeded one year.Conclusions: Co-morbid PD adversely affects AE, and there are differential effects of depression and anxiety. Asthmatic subjects with PD may benefit from more attention when establishing a treatment regimen in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…Ten of these were eligible prospective cohort studies and were included in the analysis (10)(11)(12)(20)(21)(22)(23)(24)(25)(26). The flowchart for screening studies is shown in Figure 1.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

Section: Exposure To Psychological Dysfunction (Pd)mentioning

confidence: 99%

See 1 more Smart Citation

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Zhang

Zheng³

et al. 2016

J. Thorac. Dis.

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“…The reduction in asthma self-management efficacy following exposure to AsthmaWise contradicts current knowledge which links high self-efficacy with better asthma control and asthma related quality of life (60,61). It is possible that this drop in self-management efficacy occurred because, prior to exposure to AsthmaWise, participants were unaware of the seriousness of asthma.…”

Section: Discussionmentioning

confidence: 78%

AsthmaWise – a field of dreams? The results of an online education program targeting older adults with asthma

et al. 2013

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Objectives: The aim of this study was to establish the feasibility and acceptability of an online asthma selfmanagement program developed for older Australians with asthma. Methods: AsthmaWise, an internet education self-management program, was piloted for a 3-month period at the beginning of 2012. Participants were recruited using both online and offline strategies and were required to complete surveys, both pre-and post-intervention, in a repeated measures design. Results: Matched data were collected from 51 participants; the results showed AsthmaWise to be a feasible and acceptable method of delivering asthma education to the target population. Self-reported measures showed an increase in participants' asthma knowledge, asthma control and quality of life. Results from the Perceived Health Web Site Usability Questionnaire (PHWSUQ) showed improvements between usability testing and implementation. Conclusion: The need for asthma selfmanagement education will continue to increase as the population ages and a greater number of older adults are living with asthma. This small pilot study indicates that an online asthma self-management education program can result in improved outcome measures in a target group not normally considered technologically literate. Abstract ObjectivesThe aim of this study was to establish the feasibility and acceptability of an online asthma self-management program developed for older Australians with asthma. MethodsAsthmaWise, an internet education self-management program, was piloted for a three month period at the beginning of 2012. Participants were recruited using both online and offline strategies, and were required to complete surveys, both pre and post intervention, in a repeated measures design. ResultsMatched data was collected from 51 participants; the results showed AsthmaWise to be a feasible and acceptable method of delivering asthma education to the target population.Self-reported measures showed an increase in participants' asthma knowledge, asthma control and quality of life. Results from the Perceived Health Web Site Usability Questionnaire (PHWSUQ) showed improvements between usability testing and implementation.AsthmaWise -a field of dreams? The results of an online education program targeting older adults with asthma. 2 ConclusionThe need for asthma self-management education will continue to increase as the population ages and a greater number of older adults are living with asthma. This small pilot study indicates that an online asthma self-management education program can result in improved outcome measures in a target group not normally considered technologically literate.AsthmaWise -a field of dreams? The results of an online education program targeting older adults with asthma.

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“…Self-efficacy is a well-documented predictor of treatment outcome and, together with expectancy, has been associated with subjective recovery and adherence to physiotherapy 53 and outcomes such as AQLQ score in people with asthma. 54,55 The items selected were based on Lorig's three-item Exercise Regularly Scale, 56 which was created to assess self-efficacy to perform self-management behaviours in people with chronic disease, correctly, every day and without making their symptoms worse. The three self-efficacy items are rated on a scale from 0 to10.…”

Section: Expectancy (Baseline)mentioning

confidence: 99%

A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults

Thomas

Bruton

Little

et al. 2017

Health Technol Assess

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BackgroundAsthma control is suboptimal, resulting in quality of life (QoL) impairment and costs. Breathing retraining exercises have evidence of effectiveness as adjuvant treatment, but are infrequently used.ObjectivesTo transfer the contents of a brief (three-session) physiotherapist-delivered breathing retraining programme to a digital versatile disc (DVD) and booklet format; to compare the effectiveness of the self-guided intervention with that of ‘face-to-face’ physiotherapy and usual care for QoL and other asthma-related outcomes; to perform a health economic assessment of both interventions; and to perform a process evaluation using quantitative and qualitative methods.DesignParallel-group three-arm randomised controlled trial.SettingGeneral practice surgeries in the UK.ParticipantsIn total, 655 adults currently receiving asthma treatment with impaired asthma-related QoL were randomly allocated to the DVD (n = 261), physiotherapist (n = 132) and control (usual care) (n = 262) arms in a 2 : 1 : 2 ratio. It was not possible to blind participants but data collection and analysis were performed blinded.InterventionsPhysiotherapy-based breathing retraining delivered through three ‘face-to-face’ respiratory physiotherapist sessions or a self-guided programme (DVD plus our theory-based behaviour change booklet) developed by the research team, with a control of usual care.Main outcome measuresThe primary outcome measure was asthma-specific QoL, measured using the Asthma Quality of Life Questionnaire (AQLQ). Secondary outcomes included asthma symptom control [Asthma Control Questionnaire (ACQ)], psychological state [Hospital Anxiety and Depression Scale (HADS)], hyperventilation symptoms (Nijmegen questionnaire), generic QoL [EuroQol-5 Dimensions (EQ-5D)], assessments of airway physiology (spirometry) and inflammation (exhaled nitric oxide) and health resource use and costs. Assessments were carried out at baseline and at 3, 6 and 12 months post randomisation. Patient engagement and experience were also assessed using quantitative and qualitative methods.ResultsPrimary efficacy analysis was between-group comparison of changes in AQLQ scores from baseline to 12 months in the intention-to-treat population with adjustments for prespecified covariates. Significant improvements occurred in the DVD group compared with the control group [adjusted mean difference 0.28, 95% confidence interval (CI) 0.11 to 0.44;p < 0.001] and in the face-to-face physiotherapy group compared with the control group (adjusted mean difference 0.24, 95% CI 0.04 to 0.44;p < 0.05), with equivalence between the DVD and the face-to-face physiotherapy groups (adjusted mean difference 0.04, 95% CI –0.16 to 0.24). In all sensitivity analyses, both interventions remained significantly superior to the control and equivalence between the interventions was maintained. In other questionnaire outcome measures and in the physiological measures assessed, there were no significant between-group differences. Process evaluations showed that participants engaged well with both of the active interventions, but that some participants in the DVD arm would have liked to receive tuition from a professional. Asthma health-care costs were lower in both intervention arms than in the control group, indicating ‘dominance’ for both of the interventions compared with the control, with lowest costs in the DVD arm. The rate of adverse events was lower in the DVD and face-to-face physiotherapy groups than in the control group.ConclusionsOnly 10% of the potentially eligible population responded to the study invitation. However, breathing retraining exercises improved QoL and reduced health-care costs in adults with asthma whose condition remains uncontrolled despite standard pharmacological therapy, were engaged with well by patients and can be delivered effectively as a self-guided intervention. The intervention should now be transferred to an internet-based platform and implementation studies performed. Interventions for younger patients should be developed and trialled.Trial registrationCurrent Controlled Trials ISRCTN88318003.FundingThis project was primarily funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 53. See the NIHR Journals Library website for further project information. Additional financial support was received from Comprehensive Local Research Networks.

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Self-Efficacy, Depressive Symptoms, and Patients’ Expectations Predict Outcomes in Asthma

Abstract: Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.

Cited by 141 publications

References 52 publications

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

Co-morbid psychological dysfunction is associated with a higher risk of asthma exacerbations: a systematic review and meta-analysis

AsthmaWise – a field of dreams? The results of an online education program targeting older adults with asthma

A randomised controlled study of the effectiveness of breathing retraining exercises taught by a physiotherapist either by instructional DVD or in face-to-face sessions in the management of asthma in adults

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