Thesis (M.S.)--University of Missouri-Columbia, 2008. / "May 2008" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Includes bibliographical references.

Pulmonary rehabilitation is a highly evidenced intervention used in the management of patients with chronic obstructive pulmonary disease. Both patients and healthcare professionals have anecdotally acknowledged motivation as a key element in a programme. It has been suggested by some authors that motivation should be a prerequisite to entry, yet there is no evidence to support this suggestion. The purpose of this study therefore, was to provide some theory about the role of motivation in pulmonary rehabilitation and to produce a measurement instrument to enable further quantitative study. Methods A qualitative, exploratory investigation using focus groups and face-to-face interviews with patients undergoing a pulmonary rehabilitation programme was undertaken to generate data around factors influencing motivation. Results were used to develop a 43 item self-report questionnaire. The questionnaire was administered to 77 patients before and after a pulmonary rehabilitation programme along with other health status measures. The questionnaire was tested for reliability and validity. Item reduction was performed using factor analysis. Results Motivation within the context of a PR programme was shown to consist of a number of psychological, social and circumstantial variables that fell into 3 broad dimensions: Essential motivation, external motivation and functional outcome. A key finding was that attending pulmonary rehabilitation had an enormous positive influence on the patients’ essential motivation. The questionnaire was reduced to 21 items and principal components analysis demonstrated 9 factors within the questionnaire. These were function, self-efficacy, effort, optimism, tenacity, self worth, isolation, ability and achievement. The questionnaire was named the Malvern pulmonary rehabilitation motivation questionnaire (MPMQ) for identification. The MPMQ was shown to be reliable with internal consistency, reproducibility on test-retest and sensitivity to change. Correlations were found between the MPMQ and health related quality of life, anxiety and depression, breathlessness, exercise capacity and hospital admissions during the previous 12 months. Motivation score was significantly lower in patients who dropped out of the programme and was significantly higher at the end than the start of a programme. Conclusion The MPMQ has been shown to be a reliable tool with sound evidence of validity that can be used to objectively assess patients’ motivation within the context of a pulmonary rehabilitation programme. These findings need to be supported with further evidence for the validity and reliability of the questionnaire. Further investigation of the association of MPMQ score and adherence in pulmonary rehabilitation is needed along with further exploration of the determinants of motivation. This would enable specialist staff to identify patients who are likely to have adherence problems and channel efforts into effective cognitive-behavioural interventions in the ongoing effort to establish the optimum pulmonary rehabilitation programme.

This study concerned itself with planned teaching, based on principles of adult education, as a component of the rehabilitation of patients with chronic bronchitis and emphysema. The need for teaching in this area has been recognized, but as yet not researched. The purpose of this study was to determine whether the teaching intervention, conducted in groups and on a one-to-one basis, would affect the patient's ability to recognize and treat his disease symptoms. The null hypothesis was tested: there is no significant difference in the patient's ability to recognize and treat disease symptoms after he has participated in a teaching program as compared to his ability to recognize and treat disease symptoms before participating in such a program. Using two rehabilitation facilities in large metropolitan hospitals, all patients accepted for the rehabilitation programs over a four-month period were asked to participate in the study. Ultimately, twenty patients made up the study group. Patients were instructed in diary-keeping skills and given one diary per week for four weeks before they began the rehabilitation program. These diaries were reviewed on a weekly basis with the researcher. After the patients had participated in the teaching program they were again given diaries (one per week for eight weeks) which were reviewed weekly with the researcher. The patients were asked to describe each day as being a good (comfortable) day or a bad (uncomfortable) day, to record the presence of any symptoms that they experienced, and to record any activities or treatments that they used to make themselves more comfortable. Twelve symptoms and eleven treatments were under consideration. The symptoms and treatments were divided into before and after categories and analyzed using the t ratio for non-independent groups. The results of the analysis lead to the rejection of the null hypothesis with p=0.05, indicating that patients with chronic bronchitis and emphysema were better able to cope with their illnesses after the teaching intervention. The study recommends that health care facilities establish teaching programs for patients with these illnesses, and that nurses assume greater involvement and responsiblity for teaching patients. The study concludes with recommendations for further investigation. / Applied Science, Faculty of / Nursing, School of / Graduate

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