r e s p i r a t o r y m e d i c i n e : c o p d u p d a t e 5 ( 2 0 0 9 ) 9 0 e 9 7 97

The effect of pulmonary rehabilitation on perceptions of breathlessness and activity in COPDpatients: a qualitative study

This grounded theory qualitative study explores the effect that pulmonary rehabilitation has on the perception of breathlessness and activity.

Abstract of Original Article

Aim: The aim of this study was to explore, using qualitativeresearch methods, how pulmonary rehabilitation (PR) pro-grammes affect the experience of activity and breathlessnessof people with COPD.Methods: A qualitative, interview-based approach wasemployed. Participants were interviewed pre- and post-PR.Data were analysed using systematic strategies informed bygrounded theory methods.Results: Nine participants (three female) took part. A changein participants’ perception of breathlessness and lesseningof fear of activity were the main themes identified. PR

appeared to impact on the experience of physical social activ-ities, allowing participants to overcome feelings of socialisolation.Conclusions: Prior to PR, participants associated activities withbreathlessness and panic; post PR, participants reportedreduced fear and felt able to increase their activities. Thesefindings add to our understanding of the impact of PR on indi-viduals’ experience of activity and may contribute toimproved programmes by addressing patients’ needs.Reprinted with permission from Primary Care RespiratoryJournal

Commentary by Christine MikelsonsRoyal Free NHS Trust, London, UK

Much of the early qualitative work relating to COPD 1,2 focussed on the patients’ experience of having the disease. Theunique aspect of this study is its enquiry, using grounded theory, into the impact of pulmonary rehabilitation (PR) onthe perceptions of breathlessness and activity of nine patients with COPD. The authors found that following rehabilitation,participants change in their perception of their breathlessness led to an increased confidence in performing activities dueto a decrease in fear of activity and panic and anxiety relating to breathlessness. Participants reported improved levels ofphysical activity, for example in improved walking distances and ability to do household activities like housework andgardening, and social activity with positive impacts on social isolation caused by the disease. Social isolation was relatedto two key factors: a perceived lack of social support and feeling trapped at home, for example because of having to useoxygen. Post PR participants described taking up social activities such as dancing and exercise. This study complementswork by Toms & Harrison (2002)3 which used an interpretive methodological approach involving focus groups and identi-fied isolation as a key perception held by patients with COPD undergoing PR.

The authors point out that conducting a larger mixed methods study would enable a comparison of participants’ percep-tions with physical outcomes and could provide invaluable insights into the refinement of pulmonary rehabilitation and inturn provide a better health advantage for patients with COPD in physical, psychological and social terms.

References1. Williams SJ & Bury MR. Impairment, disability and handicap in chronic respiratory illness. Social Science and Medicine 1989;

29 (5): 609-616.2. Anderson KL. The effect of chronic obstructive pulmonary disease on quality of life. Research in Nursing and Health 1995; 18:

547-556.3. Toms J & Harrison K. Living with chronic lung disease and the effect of pulmonary rehabilitation. Physiotherapy 2002; 88 (10):

605-619.

Original article reference: Williams V, Bruton A, Ellis-Hill C, McPherson K. The effect of pulmonary rehabilitation on percep-tions of breathlessness and activity in COPD patients: a qualitative study. Primary Care Respiratory Journal 2009; doi:10.4104/pcrj.2009.00044.

doi:10.1016/j.rmedu.2009.10.018