Pulmonary rehabilitation in chronic obstructive pulmonary disease : impact on patients' self-efficacy

Integrated care of chronic lung disease management comprises pulmonary rehabilitation (PR), which is an individually tailored intervention including exercise training and self-management education, purposeful on long-term adherence to health behaviour change. There is high scientific evidence that PR improves dyspnea, health status, exercise tolerance and anxiety and depression levels in people with chronic obstructive pulmonary disease (COPD), one of the most prevalent respiratory conditions worldwide. Self-efficacy (SE), defined as one’s belief of being capable of doing something to accomplish a desired goal, is considered a core outcome of self-management interventions, and a clinical and functional determinant of physical activity (PA) in people with COPD. Telemonitoring (TM) and telerehabilitation are telemedicine subsets of digital health supportive environments, that can be designed to meet high ecological validity of assessments and interventions, with potential impact on healthcare effectiveness. The aim of this thesis was to study the impact of PR on SE of people with COPD, including digitally health supportive environments such as TM and pulmonary telerehabilitation (PTR). Study I accomplished the Portuguese validation of the Pulmonary Rehabilitation Adapted-Index of Self-Efficacy (PRAISE) tool, translating, and culturally adapting this SE instrument specific to PR into European Portuguese, by means of forward-backward translation, pilot testing and content validity through a multidisciplinary panel of expert judges. Reliability and construct validity was investigated on a cross-sectional study with 150 Portuguese PR outpatients by means of statistical exploratory factorial analysis. Results were a 4-factor solution suggesting discriminative SE qualities that cumulatively explained 52.3% of SE total variance and showed a PRAISE reliability of Cronbach alpha of 0.78. To refine the accuracy of daily PA assessment methodology, Study II was a cross-sectional study with 100 PR outpatients comparing ...