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      Symptom burden and self-management in persons with chronic obstructive pulmonary disease

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          Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD.

          Patients and methods

          In this cross-sectional study with 225 participants diagnosed with COPD grades II–IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables.


          Higher symptom burden was significantly associated with worse scores in all self-management domains ( p<0.003), except for self-monitoring and insight ( p=0.012). Higher disease severity ( p=0.004) and numbers of comorbidities ( p<0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life ( p=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities ( p=0.006) and self-monitoring and insight ( p<0.001), and participation in organized physical training was associated with higher score in health-directed activities ( p<0.001). The final models explained 3.7%–31.7% of variance (adjusted R 2) across the eight heiQ scales.


          A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.

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          Most cited references 45

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          Integrating response shift into health-related quality of life research: a theoretical model.

          Patients confronted with a life-threatening or chronic disease are faced with the necessity to accommodate to their illness. An important mediator of this adaptation process is 'response shift' which involves changing internal standards, values and the conceptualization of quality of life (QOL). Integrating response shift into QOL research would allow a better understanding of how QOL is affected by changes in health status and would direct the development of reliable and valid measures for assessing changes in QOL. A theoretical model is proposed to clarify and predict changes in QOL as a result of the interaction of: (a) a catalyst, referring to changes in the respondent's health status; (b) antecedents, pertaining to stable or dispositional characteristics of the individual (e.g. personality); (c) mechanisms, encompassing behavioral, cognitive, or affective processes to accommodate the changes in health status (e.g. initiating social comparisons, reordering goals); and (d) response shift, defined as changes in the meaning of one's self-evaluation of QOL resulting from changes in internal standards, values, or conceptualization. A dynamic feedback loop aimed at maintaining or improving the perception of QOL is also postulated. This model is illustrated and the underlying assumptions are discussed. Future research directions are outlined that may further the investigation of response shift, by testing specific hypotheses and predictions about the QOL domains and the clinical and psychosocial conditions that would potentiate or prevent response shift effects.
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            Pulmonary rehabilitation for chronic obstructive pulmonary disease.

            Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.
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              The influence of social support on chronic illness self-management: a review and directions for research.

              A review of the empirical literature examining the relationship between social support and chronic illness self-management identified 29 articles, of which 22 were quantitative and 7 were qualitative. The majority of research in this area concerns diabetes self-management, with a few studies examining asthma, heart disease, and epilepsy management. Taken together, these studies provide evidence for a modest positive relationship between social support and chronic illness self-management, especially for diabetes. Dietary behavior appears to be particularly susceptible to social influences. In addition, social network members have potentially important negative influences on self-management There is a need to elucidate the underlying mechanisms by which support influences self-management and to examine whether this relationship varies by illness, type of support, and behavior. There is also a need to understand how the social environment may influence self-management in ways other than the provision of social support

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                24 January 2018
                : 13
                : 365-373
                [1 ]Department of Research and Innovation, Helse Fonna HF, Haugesund
                [2 ]Department of Quality and Health Technology, University of Stavanger, Stavanger
                [3 ]Department of Nursing, Western Norway University of Applied Sciences
                [4 ]Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
                [5 ]Health Systems Improvement Unit, School of Health and Social Development, Centre For Population Health Research, Deakin University, Burwood, Victoria, Australia
                Author notes
                Correspondence: Heidi B Bringsvor, Department of Research and Innovation, Helse Fonna HF, Postboks 2170, 5504 Haugesund, Norway, Tel +47 90 93 82 13, Email heidi.breistrand.bringsvor@
                © 2018 Bringsvor et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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