The effect of a pulmonary rehabilitation program on self-efficacy, perception of dyspnea, and physical endurance

OBJECTIVE: To determine the effect of attendance at an outpatient pulmonary rehabilitation (OPR) program on changes in self-efficacy, perception of dyspnea, and exercise endurance in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Single-group, pretest and posttest design. SETTING: A moderate sized, urban private hospital in western New York. PATIENTS: Sixty patients with a diagnosis of COPD. Their ages ranged from 35 to 82 years (mean ± SD = 65 ± 0.75 years). OUTCOME MEASURES: Scores on the COPD Self-Efficacy Scale (CSES) and the Dyspnea Scale and distance walked (feet) on the 12-minute walking-distance test (12 MD). INTERVENTION: The OPR consisted of an educational component and exercise training. Methods to increase self-efficacy were integrated into the rehabilitation program. Preprogram and postprogram measurements were obtained on the CSES, the Dyspnea Scale, and the 12 MD. RESULTS: Paired t tests were used to examine the differences in mean scores between preprogram and postprogram results on the CSES, the Dyspnea Scale, and the 12 MD. There was a significant difference between preprogram and postprogram scores on the CSES (p < 0.01), the Dyspnea Scale (p = 0.01), and the 12 MD (p = 0.04). Pearson product moment correlations showed a significant negative correlation between scores on the CSES and scores on the Dyspnea Scale (r = -0.5566, p = 0.01) and a positive correlation between scores on the CSES and the 12 MD (r = 0.4293, p = 0.05). These results indicated that higher self-efficacy scores on the CSES were correlated with lowered perception of dyspnea and greater distances walked in 12 minutes. CONCLUSIONS: An OPR can improve self-efficacy or confidence in participants' ability to manage or avoid breathing difficulty. Improvement in self-efficacy also may be a factor in decreased perception of dyspnea and increased exercise endurance. Methods to increase self-efficacy expectations with education and exercise training provide an approach to assist persons with COPD to manage their breathing difficulty more effectively. Further studies rising a randomized experimental, control design are needed to provide more conclusive direction with regard to effective methods in pulmonary rehabilitation.