Abstract
The rehabilitation of chronic obstructive pulmonary disease (COPD) aims to raise participants' adaptation to an illness that is incurable and which causes an insidious decline of health and quality of life. Treatment educates patients about the disease, improves their physical fitness despite breathlessness, and raises their confidence and morale. Robust COPD-specific measures have been developed to evaluate each of the main treatment goals above except confidence, i. e. coping beliefs. This study concerns the development of a COPD coping beliefs measure addressing, in particular, self-efficacy and fear-avoidance beliefs, because of the significance of these elsewhere in the literature on the self-management of chronic illness. A clinical team of a physician, physiotherapists, nurses, and a psychologist, who all specialize in pulmonary rehabilitation, generated a set of questions they deemed most relevant for coping with COPD and the goals of rehabilitation. Feedback on the questionnaire was obtained from twelve patients. 65 people then completed the modified version prior to their rehabilitation. Additional feedback, item analysis, and test-retest data led to further revisions, shortening the questionnaire. This was then completed by a new sample of 121 people with severe COPD before and after their rehabilitation. Statistical analysis suggested a 2-factor structure reflecting self-efficacy and fear-avoidance beliefs, comprising 7 and 4 items respectively. These had acceptable psychometric properties including internal consistency and retest reliability. The 2-factor structure was stable on post-treatment reassessment. Comparison of total scores for each of the 2 factors suggests the measure is sensitive to change with treatment. This revised measure appears useful and relevant for the evaluation of COPD rehabilitation. It is straightforward to administer and analyse. Further standardization is needed for the 11-item version to validate a threshold of clinically meaningful change. The measure is recommended as part of the framework for evaluating COPD rehabilitation but the need for a clearer definition of this treatment is also discussed.