Figures
- FIGURE 1
Flow chart of the study. PCP: primary care practice; HCS: home care service; COPD-GRIP: Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception.
- FIGURE 2
Clinical COPD Questionnaire (CCQ) scores over time. Data are presented as mean (95% CI).
- FIGURE 3
Mean health-directed behaviour scores over time. Data are presented as mean (95% CI).
- FIGURE 4
Mean Brief Illness Perception Questionnaire (B-IPQ) personal control scores over time. Data are presented as mean (95% CI)
Tables
- TABLE 1
The COPD-GRIP (Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception) intervention
The COPD-GRIP intervention is applied individually for each patient and consists of three face-to-face consultations, each lasting ∼30 min
The three consultations are scheduled at ∼3-week intervals
The specific content is individualised, based on the patient's questions, responses and the needs of the patientFirst consultation: understanding the patient's illness perceptions 1) Identifying and understanding patient's illness perceptions;
2) Assessing and discussing illness perceptions using the B-IPQ as a guide for tailoring the interventionSecond consultation: identifying the link between illness perceptions and behaviour 1) Identifying the link between illness perceptions and behaviour
2) Improving the patient's understanding of the relationship between their perceptions
and their behaviour, by challenging them to draw up an individual care plan (a
short-term goal and a long-term goal, with strategies to achieve these)Third consultation: evaluating and discussing the individual care plan 1) Evaluating and discussing the individual care plan
2) Evaluating and assessing whether the individual care plan was successful and what new actions are necessary for the future
3) If the patient did not describe a care plan, discussing actions for the futureB-IPQ: Brief Illness Perception Questionnaire.
- TABLE 2
Patient characteristics
Intervention Usual care Subjects 100 99 Clusters 17 18 Age years 68.04±9.64 65.78±9.61 Male 45 (45.9) 45 (45.4) FEV1 % predicted 60.6±17.6 60.5±20.1 GOLD stage# I (mild) 9 (9.2) 9 (9.0) II (moderate) 61 (62.2) 63 (63.6) III (severe) 23 (23.5) 18 (18.2) IV (very severe) 5 (5.1) 9 (9.1) Education level Lower secondary or less 70 (71.4) 65 (65.6) Upper secondary 18 (18.4) 21 (21.2) College/university 10 (10.2) 8 (8.1) Current smoker 27 (27.6) 32 (32.3) Living alone 44 (44.9) 39 (39.4) Contact with healthcare professional¶ Nurse 268 195 GP 323 263 Physiotherapist 414 360 Dietician 6 33 Increase of complaints+ 248 (30.3) 177 (22.3) Hospital admissions§ 13 11 Comorbidities Myocardial infarction 9 (9.1) 6 (6.1) Heart failure 11 (11.1) 4 (4.1) Cerebrovascular accident 6 (6.1) 3 (3.1) Diabetes 5 (5.1) 21 (21.1) Data are presented as n, mean±sd or n (%). FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; GP: general practitioner. #: I (mild): FEV1 ≥80% pred; II (moderate): FEV1 ≥50% to <80% pred; III (severe): FEV1 ≥30% to <50% pred; IV (very severe): FEV1 <30% pred; ¶: total counts of contacts during study period (intervention period of 6 weeks and 9-month follow-up); +: total counts of reported increase of complaints during study period (intervention period of 6 weeks and 9-month follow-up); §: total counts of reported hospital admissions during study period (intervention period of 6 weeks and 9-month follow-up).
- TABLE 3
Baseline measurements
Intervention Ususal care Reference range CCQ# 1.9±1.2 1.6±1.1 0–6 Symptoms 2.2±1.2 2.0±1.1 Functional state 2.0±1.5 1.7±1.4 Mental state 1.0±1.3 0.9±1.1 B-IPQ Consequences 5.5±2.9 4.9±2.8 0.0–10.0 Timeline 9.5±1.6 9.6±1.7 0.0–10.0 Personal control 5.5±2.7 6.4±2.3 0.0–10.0 Treatment control 7.0±2.6 7.0±2.0 0.0–10.0 Identity 5.4±2.5 4.9±2.7 0.0–10.0 Concern 5.0±3.0 5.4±3.1 0.0–10.0 Comprehensibility 7.6±2.4 7.1±2.6 0.0–10.0 Emotional response 3.9±3.2 3.6±2.9 0.0–10.0 MRC+ 2.2±1.3 1.9±1.4 0–5 CRQ-SAS§ Dyspnoea 5.8±1.4 5.6±1.5 1–8 Fatigue 4.5±1.4 4.7±1.4 1–7 Emotional 5.0±1.2 5.2±1.2 1–7 Mastery 5.4±1.2 5.4±1.3 1–7 FPI§ 1.7±0.7 1.8±0.6 1–3 heiQ§ Health-directed behaviour 2.9±0.7 3.1±0.7 1–4 Positive and active engagement in life 3.0±0.6 3.1±0.5 1–4 Emotional distress 3.1±0.7 3.1±0.7 1–4 Self-monitoring and insight 3.1±0.4 3.1±0.4 1–4 Constructive attitudes and approaches 3.2±0.6 3.3±0.5 1–4 Skill and technique acquisition 3.0±0.4 3.0±0.5 1–4 Social integration and support 3.0±0.6 3.0±0.6 1–4 Health service navigation 3.2±0.4 3.2±0.4 1–4 Data are presented as mean±sd or n. CCQ: Clinical COPD Questionnaire; B-IPQ: Brief Illness Perception Questionnaire; MRC: Medical Research Council dyspnoea score; CRQ-SAS: self-administered Chronic Respiratory Disease Questionnaire short form; FPI: Functional Performance Inventory; heiQ: Health Education Impact Questionnaire. #: lower scores mean better health-related quality of life (HRQoL); ¶: lower scores on consequences, timeline, identity, concern and emotional response and higher scores on personal control, treatment control and comprehensibility mean more positive perceptions; +: lower scores mean less burden of dyspnoea; §: higher scores mean better HRQoL, functional performance and health education impact.
- TABLE 4
Clinical outcomes, corrected for clustering, time, treatment and Medical Research Council dyspnoea score# for the COPD-GRIP (Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception) intervention group and the usual-care group
Baseline 6 weeks 3 months 9 months Mean difference (95% CI) Treatment*time interaction at 9 months
p-valuesCCQ total¶ 0.04 (−0.09–0.17) 0.197 Intervention 1.9±1.2 1.8±1.1 2.0±1.3 2.0±1.2 Usual care 1.6±1.1 1.7±1.1 1.8±1.1 1.7±1.1 CRQ-SAS+ fatigue −0.06 (−0.28–0.16) 0.631 Intervention 4.5±1.4 4.5±1.5 4.5±1.5 4.4±1.4 Usual care 4.7±1.4 4.8±1.4 4.7±1.3 4.7±1.4 CRQ-SAS+ dyspnoea 0.16 (−0.13–0.04) 0.162 Intervention 5.8±1.4 5.6±1.6 5.6±1.5 5.5±1.6 Usual care 5.6±1.5 5.6±1.5 5.6±1.4 5.7±1.5 CRQ-SAS+ emotional 0.03 (−0.21–0.27) 0.463 Intervention 5.0±1.2 5.2±1.3 5.2±1.3 5.1±1.3 Usual care 5.2±1.2 5.3±1.2 5.2±1.1 5.3±1.2 CRQ-SAS+ mastery 0.09 (−0.11–0.28) 0.375 Intervention 5.4±1.0 5.4±1.1 5.3±1.3 5.3±1.2 Usual care 5.4±1.3 5.4±1.3 5.4±1.2 5.5±1.2 FPI+ −0.12 (−0.33–0.08) 0.074 Intervention 1.7±0.7 1.6±0.7 1.6±0.7 1.5±0.7 Usual care 1.8±0.6 1.8±0.7 1.7±0.7 1.8±0.7 B-IPQ§ (control) −0.22 (−0.70–0.26) 0.005 Intervention 5.5(2.7 6.5±2.1 6.1±2.5 6.6±2.2 Usual care 6.4±2.3 6.5±2.1 6.9±1.7 6.2±2.3 heiQ+ (HDB) −0.12 (−0.26–0.03) 0.024 (6 weeks) Intervention 2.8±0.7 3.1±0.7 3.0±0.5 2.9±0.8 Usual care 3.1±0.7 3.1±0.6 3.1±0.6 3.1±0.6 Data are presented as mean±sd, unless otherwise stated. CCQ: Clinical COPD Questionnaire; CRQ-SAS: self-administered Chronic Respiratory Disease Questionnaire short form; FPI: Functional Performance Inventory; B-IPQ: brief illness perception questionnaire; heiQ: Health Education Impact Questionnaire; HDB: health-directed behaviour. #: lower scores mean less burden of dyspnoea; ¶: lower score means better health-related quality of life (HRQoL); +: higher scores mean better HRQoL, functional performance and health education impact; §: lower scores on consequences, identity, concern and emotional response and higher scores on timeline, personal control, treatment control and comprehensibility mean more positive perceptions.
- TABLE 5
Subgroup analyses: differences between the COPD-GRIP (Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception) intervention group and the usual-care group in Clinical COPD Questionnaire scores
Subjects n Baseline 6 weeks 3 months 9 months Treatment*time interaction
p-valuesMRC score ≤2 0.595 Intervention 64 1.3±0.7 1.3±0.7 1.3±0.9 1.5±0.8 Usual care 68 1.2±0.8 1.2±0.8 1.3±0.8 1.3±0.7 MRC score >2 0.165 Intervention 20 3.0±1.1 3.0±1.1 3.2±1.1 3.2±1.1 Usual care 23 2.7±0.9 2.9±1.0 3.0±0.9 3.0±1.0 Male 0.811 Intervention 33 1.8±1.3 1.4±0.9 1.8±1.3 1.7±1.0 Usual care 41 1.7±1.0 1.9±1.1 1.8±1.1 1.8±1.3 Female 0.126 Intervention 51 2.2±1.3 2.1±1.2 2.3±1.4 2.2±1.3 Usual care 53 1.6±1.1 1.6±1.2 1.8±1.1 1.6±1.0 Data are presented as mean±sd, unless otherwise stated. MRC: Medical Research Council.
