title: Development and feasibility of a self-management intervention for chronic obstructive pulmonary disease delivered with motivational interviewing strategies.
abstract: BACKGROUND
  Self-management is proposed as the standard of care in chronic obstructive pulmonary disease (COPD), but details of the process and training required to deliver effective self-management are not widely available. In addition, recent data suggest that patient engagement and motivation are critical ingredients for effective self-management. This article carefully describes a self-management intervention using motivational interviewing skills, aimed to increase engagement and commitment in severe COPD patients.
  
  
  METHODS
  The intervention was developed and pilot tested for fidelity to protocol, for patient and interventionist feedback (qualitative) and effect on quality of life. Engagement between patient and interventionists was measured by the Working Alliance Inventory. The intervention was refined on the basis of the results of the pilot study and delivered in the active arm of a prospective randomized study.
  
  
  RESULTS
  The pilot study suggested improvements in quality of life, fidelity to theory, and patient acceptability. The refined self-management intervention was delivered 540 times in the active arm of a randomized study. We observed a retention rate of 86% (patients missing or not available for only 14% the scheduled encounters).
  
  
  CONCLUSIONS
  A self-management intervention that includes motivational interviewing as the way if guiding patients into behavior change is feasible in severe COPD and may increase patient engagement and commitment to self-management. This provides a very detailed description of the process for the specifics of training and delivering the intervention, which facilitates replicability in other settings and could be translated to cardiac rehabilitation.
authors: Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. benzo.roberto@mayo.edu
authors: Roberto
authors: R
authors: Benzo
authors: Kristin
authors: K
authors: Vickers
authors: Denise
authors: D
authors: Ernst
authors: Sharon
authors: S
authors: Tucker
authors: Charlene
authors: C
authors: McEvoy
authors: Kate
authors: K
authors: Lorig
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires