Implications for practice and research

Interactive teaching, based on self-regulation theory provided through on-site and telephone conversations with patients, is effective for judging the meaning of chronic obstructive pulmonary disease (COPD) symptoms and for indicating how to react timely to indications of exacerbations.

Using a self-regulation protocol in a clinical setting improves dyspnoea, symptom distress, pulmonary physical functioning and self-efficacy of COPD, and reduces unscheduled physician visits due to exacerbations.

Context

While COPD is already a major health problem worldwide, its prevalence is on the rise. COPD causes high morbidity and mortality and represents a substantial economic and social burden throughout the world.1 A growing emphasis has been placed on self-management-focused education programmes to help patients manage the disease on a daily basis, thus preventing exacerbations and preserving health. The effectiveness of these programmes is, however, inconclusive.2 Kuo and colleagues developed a research-based protocol rooted in self-regulation theory, as articulated by Clark et al3 to address self-management. They tested the programme on a group of patients mainly affected by mild and moderate COPD. As underscored in the theory, the authors emphasised that patients need individual guidance to monitor, judge the meaning of and react to the symptoms of the disease, particularly as regard factors that may trigger exacerbations.

Findings

Patients with GOLD stages I and II who received the self-regulation intervention had significantly less dyspnoea and symptom distress, better pulmonary physical functioning, better self-efficacy of COPD and better peak expiratory flow, compared with the control group at 13 weeks of follow-up. Patients in the experimental group had significantly fewer unscheduled physician visits due to exacerbations.

Commentary

This study showed the benefits of teaching patients with mild and moderate COPD self-regulation knowledge and skills with the use of a self-regulation guidebook. The findings are more positive than in several previous studies, where there was a significant difference between the experimental and control group on all of the variables at 13 weeks of follow-up. The outcome variables are multitude; physiological, psychological and social functions as well as the use of healthcare, which adds further value to the findings. It is also noteworthy that the authors were able to recruit people with milder stages of COPD than in several comparable studies. The study period of 13 weeks is shorter than commonly found. Future studies should extend the study period to test whether the effectiveness of the self-regulation intervention lasts over a longer term period—1 year, for example.

The guidebook that the authors developed contained worksheets (a self-monitoring record sheet, a self-judgement record sheet and self-reaction guidelines) for patients to fill out. More research is needed to test the use of such worksheets, but in the meantime it would be helpful to make evidence-based clinical tools such as these more readily available to clinicians for use in daily practice. The authors point out that not all patients may have the capacity to make full use of the self-regulation guidebook. This is an important point which demonstrates the necessity of including the family when healthcare for people with COPD is organised. The disease affects the whole family; to maximise resources, the family needs to be involved in the monitoring of COPD, in judging the meaning of its symptoms and in acting on that information.