Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study
Restricted accessResearch articleFirst published online September, 2019
Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study
Self-management of patients with COPD has received increasing attention in recent years given its association with improved outcomes. There is a scarcity of feasible interventions that can improve self-management abilities. We recently reported the positive effect of health coaching, started at the time of hospital discharge, on re-hospitalizations and emergency department visits for patients with COPD admitted for an exacerbation. In this substudy, we aimed to investigate the effects of health coaching delivered by a respiratory therapist or a nurse compared with guideline-based usual care on self-management abilities in COPD.
METHODS:
Self-management was measured by using the Chronic Respiratory Disease Questionnaire mastery domain and was assessed at baseline, at 6 months, and at 12 months after hospitalization.
RESULTS:
Two hundred and fifteen subjects hospitalized for a COPD exacerbation were randomized to the intervention or the control. The mean change in the Chronic Respiratory Disease Questionnaire mastery score from baseline to month 6 was Δ0.58 32 ± 1.29 on the intervention arm and Δ0.17 32 ± 1.14 on the control arm (P = .02). Of the intervention subjects, 55% had at least a 0.5-point increase in Chronic Respiratory Disease Questionnaire mastery (minimum clinically important difference) compared with 38% in the control group. Health coaching was an independent predictor of the minimum clinically important difference or greater change in the Chronic Respiratory Disease Questionnaire mastery score at 6 months after initiation of the intervention (odds ratio 1.95, 95% CI 1.01–3.79). The changes in the Chronic Respiratory Disease Questionnaire mastery score at 12 months showed a trend but did not attain statistical significance.
CONCLUSIONS:
Health coaching delivered by a respiratory therapist or a nurse improved self-management abilities when applied to subjects with COPD after hospital discharge for an exacerbation. (ClinicalTrials.gov Identifier: NCT01058486, Mayo IRB 09–004341).
EffingTW, VercoulenJH, BourbeauJ, TrappenburgJ, LenferinkA, CafarellaP, et al. Definition of a COPD self-management intervention: International Expert Group consensus. Eur Respir J, 2016; 48(1):46–54.
2.
SpruitMA, SinghSJ, GarveyC, Zu WallackR, NiciL, RochesterC, et al.; ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013; 188(8):e13–64.
3.
BenzoR, VickersK, NovotnyPJ, TuckerS, HoultJ, NeuenfeldtP, et al. Health coaching and chronic obstructive pulmonary disease re-hospitalization: a randomized study. Am J Respir Crit Care Med, 2016; 194(6):672–680.
4.
BoardmanT, CatleyD, GrobeJE, LittleTD, AhluwaliaJS. Using motivational interviewing with smokers: do therapist behaviors relate to engagement and therapeutic alliance?. J Subst Abuse Treat, 2006; 31(4):329–339.
5.
BorrelliB, RiekertKA, WeinsteinA, RathierL. Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. J Allergy Clin Immunol, 2007; 120(5):1023–1030.
6.
MillerW. RS. Motivational interviewing: Helping People Change. In WilliamRM, StephenR.(Applications of Motivational Interviewing). 3rd edition. New York, New York: The Guilford Press; 2013:335–351.
7.
MillerWR, YahneCE, MoyersTB, MartinezJ, PirritanoM. A randomized trial of methods to help clinicians learn motivational interviewing. J Consult Clin Psychol, 2004; 72(6):1050–1062.
8.
BanduraA. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev, 1977; 84(2):191–215.
9.
BenzoRP, KirschJL. Emotional Intelligence in COPD: The Impact on Self-Management Abilities and Quality of Life, American Thoracic Society International Conference, Denver, CO, May 15-20, 2015.
10.
Abascal-BoladoB, NovotnyPJ, SloanJA, KarpmanC, DuloheryMM, BenzoRP. Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire. Int J Chron Obstruct Pulmon Dis, 2015; 10:2295–2301.
11.
BenzoR, VickersK, ErnstD, TuckerS, McEvoyC, LorigK. Development and feasibility of a self-management intervention for chronic obstructive pulmonary disease delivered with motivational interviewing strategies. J Cardiopulm Rehabil Prev, 2013; 33(2):113–123.
12.
WilliamsJE, SinghSJ, SewellL, GuyattGH, MorganMD. Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax, 2001; 56(12):954–959.
13.
PanagiotiM, ScottC, BlakemoreA, CoventryPA. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2014; 9:1289–1306.
14.
VestboJ, HurdSS, AgustiAG, JonesPW, VogelmeierC, AnzuetoA, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013; 187(4):347–365.
15.
BourbeauJ, JulienM, MaltaisF, RouleauM, BeaupréA, BéginR, et al.; Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Santé du Québec. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med, 2003; 163(5):585–591.
16.
BenzoRP, KirschJL, HathawayJC, McEvoyCE, VickersKS. Health coaching in severe COPD after a hospitalization: a qualitative analysis of a large randomized study. Respir Care, 2017; 62(11):1403–1411.
17.
JonesSE, GreenSA, ClarkAL, DicksonMJ, NolanAM, MoloneyC, et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence. Thorax, 2014; 69(2):181–182.
18.
KeatingA, LeeA, HollandAE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis, 2011; 8(2):89–99.
19.
BenzoRP, Abascal-BoladoB, DuloheryMM. Self-management and quality of life in chronic obstructive pulmonary disease (COPD): the mediating effects of positive affect. Patient Educ Couns, 2016; 99(4):617–623.
20.
BentsenSB, Wentzel-LarsenT, HenriksenAH, RokneB, WahlAK. Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation–an exploratory study. Patient Educ Couns, 2010; 81(1):5–13.
21.
ZhangC, WangW, LiJ, CaiX, ZhangH, WangH, WangX. Development and validation of a COPD self-management scale. Respir Care, 2013; 58(11):1931–1936.
22.
VincentE, SewellL, WaggK, DeaconS, WilliamsJ, SinghS. Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool. Chest, 2011; 140(6):1534–1539.
23.
BucknallCE, MillerG, LloydSM, ClelandJ, McCluskeyS, CottonM, et al. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ, 2012; 344:e1060.
24.
RiceKL, DewanN, BloomfieldHE, GrillJ, SchultTM, NelsonDB, et al. Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med, 2010; 182(7)890–896.
25.
FanVS, GazianoJM, LewR, BourbeauJ, AdamsSG, LeathermanS, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Ann Intern Med, 2012; 156(10):673–683.
26.
MitchellKE, Johnson-WarringtonV, AppsLD, BankartJ, SewellL, WilliamsJE, et al. A self-management programme for COPD: a randomised controlled trial. Eur Respir J, 2014; 44(6):1538–1547.
27.
TrappenburgJC, MonninkhofEM, BourbeauJ, TroostersT, SchrijversAJ, VerheijTJ, LammersJW. Effect of an action plan with ongoing support by a case manager on exacerbation-related outcome in patients with COPD: a multicentre randomised controlled trial. Thorax, 2011; 66(11):977–984.
28.
MonninkhofE, van der ValkP, van der PalenJ, van HerwaardenC, ZielhuisG. Effects of a comprehensive self-management programme in patients with chronic obstructive pulmonary disease. Eur Respir J, 2003; 22(5):815–820.
29.
GadouryMA, SchwartzmanK, RouleauM, MaltaisF, JulienM, BeaupréA, et al.; Chronic Obstructive Pulmonary Disease axis of the Respiratory Health Network, Fonds de la recherche en santé du Québec (FRSQ). Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respir J, 2005; 26(5):853–857.
30.
BischoffEW, AkkermansR, BourbeauJ, van WeelC, VercoulenJH, SchermerTR. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial. BMJ, 2012; 345:e7642.
31.
Sánchez-NietoJM, Andújar-EspinosaR, Bernabeu-MoraR, HuC, Gálvez-MartínezB, Carrillo-AlcarazA, et al. Efficacy of a self-management plan in exacerbations for patients with advanced COPD. Int J Chron Obstruct Pulmon Dis, 2016; 11:1939–1947.
32.
Johnson-WarringtonV, ReesK, GelderC, MorganMD, SinghSJ. Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial. Int J Chron Obstruct Pulmon Dis, 2016; 11:1161–1169.
33.
CrammJM, StratingMM, de VreedePL, SteverinkN, NieboerAP. Validation of the self-management ability scale (SMAS) and development and validation of a shorter scale (SMAS-S) among older patients shortly after hospitalisation. Health Qual Life Outcomes, 2012; 10:9.
34.
RehmanH, KarpmanC, Vickers DouglasK, BenzoRP. Effect of a motivational interviewing-based health coaching on quality of life in subjects with COPD. Respir Care, 2017; 62(8):1043–1048.
35.
BenzoR. Satori: awakening to outcomes that matter: the impact of social support in chronic obstructive pulmonary disease. Ann Am Thorac Soc, 2017; 14(9):1385–1386.
