Can we identify patients with different illness schema following an acute exacerbation of COPD: a cluster analysis.
BACKGROUND
Pulmonary Rehabilitation (PR) reduces hospital admissions following an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) but adherence is known to be poor. Patients' illness perceptions may affect adherence to disease-management strategies but to date have not been explored following an exacerbation. The study aim is two-fold; firstly to prospectively explore acceptance and uptake of post-exacerbation PR and secondly to identify possible clusters of patients' illness perceptions following hospitalisation for an exacerbation of COPD.


METHODS
Patients admitted to hospital with an exacerbation of COPD were recruited to a prospective observational study. Self-reported illness perceptions, mood, health status and self-efficacy were assessed. Acceptance and uptake of PR were recorded at six months. Cluster analysis of Illness Perceptions Questionnaire-Revised data was used to establish groups of patients holding distinct beliefs.


RESULTS
128 patients were recruited. Acceptance and uptake of PR following an acute exacerbation was poor with only 9% (n = 11) completing the programme. Cluster analysis revealed three distinct groups: Cluster 1 'in control' (n = 52), Cluster 2 'disengaged' (n = 36) and Cluster 3 'distressed' (n = 40). Significant between-cluster differences were observed in mood, health status and self-efficacy (p < 0.01). Acceptance and uptake of PR did not differ between clusters.


CONCLUSIONS
Acceptance/uptake of post-exacerbation PR was found to be poor. Three distinct illness schema exist in patients following an acute exacerbation. This information may be useful in developing novel psychologically-informed interventions designed to reduce feelings of distress and perhaps facilitate a PR intervention for this vulnerable population.
Pulmonary Rehabilitation Research Group, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK; University of Leicester, University Road, Leicester LE1 7RH, UK. Electronic address: samantha.harrison@westpark.org.
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SL
Harrison
University of Leicester, University Road, Leicester LE1 7RH, UK.
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N
Robertson
Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK; NHS Lothian, Department of Clinical Neuropsychology, Astley Ainslie Hospital, Edinburgh EH9 2HL, UK.
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CD
Graham
Pulmonary Rehabilitation Research Group, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK.
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J
Williams
Pulmonary Rehabilitation Research Group, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK.
M C
MC
Steiner
Pulmonary Rehabilitation Research Group, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK.
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MD
Morgan
Pulmonary Rehabilitation Research Group, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK; Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK.
S J
SJ
Singh
D000208:Acute Disease; D000368:Aged; D001007:Anxiety / Q000209:etiology; D016000:Cluster Analysis; D003863:Depression / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020377:Self Efficacy
Chronic obstructive pulmonary disease (COPD); Cluster analysis; Exacerbations; Illness perceptions; Psychological interventions; Pulmonary rehabilitation (PR)