Can we identify patients with different illness schema following an acute exacerbation of COPD: A cluster analysis

Probably not a substantial claim: may not pass S3 (load-bearing).

The Pulmonary Rehabilitation Adapted Index of Self-efficacy is fully validated in a pulmonary rehabilitation population.

“The PRAISE is an adapted version of the General Self-Efficacy Scale (GSES) [34] developed specifically for use in PR and has been fully validated in a PR population [33].”

• cites [33] Vincent, 2011, Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool, Chest sourcePartly supported

  The PRAISE-tool section says the authors adapted the General Self-Efficacy Scale specifically for patients in pulmonary rehabilitation. The Conclusions report that PRAISE was reproducible and sensitive to change in that population, but propose it as a practical instrument rather than establishing that it was *fully validated*. Page numbers were not available in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Chronic Respiratory Questionnaire-Self reported is a valid and reliable measure of health status in patients with COPD.

“The CRQ-SR is a self-reported measure of health status shown to be a valid and reliable in patients with COPD [32].”

• cites [32] Williams, 2003, Health status measurement: sensitivity of the self-reported Chronic Respiratory Questionnaire (CRQ-SR) in pulmonary rehabilitation, Thorax sourcePartly supported

  The Abstract describes the CRQ-SR as a reproducible and reliable measure of health status, and the Discussion finds it sensitive to change in patients with COPD undergoing pulmonary rehabilitation. Our copy does not establish its validity more broadly, so the validity part of the claim is not supported. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Adherence to oxygen therapy has been found to diminish mastery over symptoms.

“Previously, adherence to oxygen therapy has been found to diminish mastery over symptoms [38].”

• cites [38] Katsenos, 2011, Long-term oxygen therapy in COPD: factors affecting and ways of improving patient compliance, Pulm Med sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The disease presentations are conceptualised as distressing (Cluster 3 'distressed'), providing the focus of several theory-based intervention models including Cognitive Behavioural Therapy, Mindfulness, and Acceptance and Commitment Therapy.

“The disease presentations are conceptualised as distressing (Cluster 3 'distressed') providing the focus of several theory-based intervention models including; Cognitive Behavioural Therapy (CBT) [42], Mindfulness [43] and Acceptance and Commitment Therapy (ACT) [44].”

• cites [42] Brooks, 2011, The role of acceptance in chronic fatigue syndrome, J Psychosom Res sourceNot checked — no full text of the source
• cites [43] Grossman, 2010, MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial, Neurology sourceSupported
• cites [44] Forman, 2012, Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy, Behav Ther sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Mindfulness used in combination with acceptance has been found to successfully reduce stress and improve quality of life and control in patients with asthma.

“Such an intervention has been found to successfully reduce stress and improve quality of life and control in patients with asthma [45].”

• cites [45] Pbert, 2012, Effect of mindfulness training on asthma quality of life and lung function: a randomised controlled trial, Thorax sourcePartly supported

  The Discussion reports clinically significant improvements in asthma-related quality of life, and Results > Secondary Outcomes reports significantly reduced perceived stress after MBSR (page numbers unavailable). The same Results section says improvement in well-controlled asthma was not statistically significant compared with controls, so the claim of improved asthma control is not established. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Scores from the IPQ-R domain 'treatment control' are comparable to a stable population of patients with COPD.

“The scores from the IPQ-R domain 'treatment control' are comparable to a stable population of patients with COPD [39]”

• cites [39] Fischer, 2010, The dynamics of illness perceptions: testing assumptions of Leventhal's common-sense model in a pulmonary rehabilitation setting, Br J Health Psychol sourcePartly supported

  Table 4 reports IPQ-R treatment-control scores for patients with COPD before and after pulmonary rehabilitation, providing values for a comparison. But the Participants section does not identify this as a stable COPD population, and the Discussion cautions that removing the curability item makes its scores difficult to compare with other studies. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the 128 patients recruited, 70 (55%) accepted a referral to pulmonary rehabilitation.

“Of the 128 patients recruited, 70 (55%) accepted a referral to PR and one accepted a referral to Cardiac Rehabilitation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

At six months following hospital discharge, 29 (23%) patients had enrolled in pulmonary rehabilitation classes.

“At six months 39 (30%) patients had attended their initial assessment, 29 (23%) had enrolled in the PR classes and 11 (9%) patients had completed the programme (Fig. 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

128 patients were recruited to the study.

“128 patients were recruited.”

• Also stated in: § Sample · plain

  “128 were successfully recruited.”

Probably not a substantial claim: may not pass S3 (load-bearing).

At six months following hospital discharge, 39 (30%) patients had attended their initial assessment for pulmonary rehabilitation.

“At six months 39 (30%) patients had attended their initial assessment, 29 (23%) had enrolled in the PR classes and 11 (9%) patients had completed the programme (Fig. 1).”

May combine two claims.

Cluster analysis revealed three distinct groups: Cluster 1 'in control' (n=52), Cluster 2 'disengaged' (n=36), and Cluster 3 'distressed' (n=40).

“Cluster analysis revealed three distinct groups: Cluster 1 'in control' (n Z 52), Cluster 2 'disengaged' (n Z 36) and Cluster 3 'distressed' (n Z 40).”

• Also stated in: § Cluster analysis · plain

  “Three clusters emerged from the analysis.”

Probably not a substantial claim: may not pass S4 (based).

Acceptance or uptake of post-exacerbation pulmonary rehabilitation is poor.

“Acceptance/uptake of post-exacerbation PR is poor”

May combine two claims.

Patients in Cluster 3 ('distressed') experienced more severe symptoms of anxiety and depression (p < 0.001), worse health status in all four domains of the CRQ-SR (p < 0.001), and lower self-efficacy (p < 0.01) than those in Cluster 1 ('in control').

“Patients in Cluster 3 ('distressed') experienced more severe symptoms of anxiety and depression (p < 0.001), worse health status in all four domains of the CRQ-SR (p < 0.001) and had lower selfefficacy (p < 0.01) than those in Cluster 1 ('in control').”

May combine two claims.

In Cluster 3 ('distressed'), personal and treatment control were correlated (r=0.46, p<0.01), and identity and personal control were correlated (r=0.43, p<0.01).

“In Cluster 3 ('distressed') personal and treatment control were correlated (r Z 0.46, p < 0.01), other associations were between identity and personal control (r Z 0.43, p < 0.01).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Six months following discharge from hospital, 12 (9%) patients had died.

“Six months following discharge from hospital 12 (9%) patients had died.”

May combine two claims.

Patients in Cluster 1 ('in control') were less disabled by breathlessness (lower MRC grade) than those in Cluster 2 ('disengaged') (p < 0.001) or Cluster 3 ('distressed') (p < 0.001).

“As shown in Table 1 patients in Cluster 1 ('in control') were significantly older than those in Cluster 3 ('distressed') (p < 0.01) and were less disabled by their breathlessness (lower MRC grade) than Cluster 2 ('disengaged') (p < 0.001) or Cluster 3 ('distressed') (p < 0.001).”

May combine two claims.

In Cluster 2 (n=36), patients displayed lower illness coherence and personal control, associated more symptoms with their disease, had weaker emotional representations, reported fewer consequences, and perceived a less chronic timeline.

“Patients in Cluster 2 (n Z 36) displayed lower illness coherence and personal control, associated more symptoms with their disease but had weaker emotional representations, reported fewer consequences and perceived a less chronic timeline.”

May combine two claims.

In Cluster 1 ('in control'), significant relationships existed between timeline and consequences (r=0.46, p<0.01), emotional representations and treatment control (r=0.32, p<0.05), and illness coherence and treatment control (r=0.34, p<0.05).

“In Cluster 1 ('in control') significant relationships existed between timeline and consequences (r Z 0.46, p < 0.01), emotional representations and treatment control (r Z 0.32, p < 0.05) and illness coherence and treatment control (r Z 0.34, p < 0.05).”

May combine two claims.

In Cluster 3 (n=40), patients had higher illness coherence, perceived a higher number of symptoms to be associated with their disease, and perceived greater consequences and a cyclical timeline.

“In Cluster 3 (n Z 40) patients had higher illness coherence, perceived a higher number of symptoms to be associated with their disease and for it to have greater consequences and a cyclical timeline.”

May combine two claims.

Patients in Cluster 1 ('in control') and Cluster 3 ('distressed') were found to have the same level of understanding, but the way the disease affected them emotionally differed significantly between the groups.

“patients in Cluster 1 ('in control') and Cluster 3 ('distressed') were found to have the same level of understanding but the way in which the disease affected them emotionally differed significantly between the groups.”

May combine two claims.

In Cluster 2 ('disengaged'), personal and treatment control correlated with each other (r=0.46, p<0.01), identity and timeline cyclical correlated (r=0.49, p<0.01), and timeline and consequences correlated (r=0.42, p<0.05).

“In Cluster 2 ('disengaged') personal and treatment control correlated with each other (r Z 0.46, p < 0.01), other associations were between identity and timeline cyclical (r Z 0.49, p < 0.01) and timeline and consequences (r Z 0.42, p < 0.05).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Only 72% (n=92) of patients completed all the other questionnaires (HADS, CRQ-SR, PRAISE).

“All patients completed the IPQ-R during the study visit but only 72% (n Z 92) of patients completed all the other questionnaires (HADS, CRQ-SR, PRAISE).”

May combine two claims.

68% of patients cited smoking as the primary cause of their disease, and 9% considered work environment to be the cause.

“Information gleaned from the causal domain of the IPQ-R revealed that 68% of patients cited smoking as the primary cause of their disease, 9% considered work environment to be the cause with other causes including; aging, a germ or virus and passive smoking.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Following an acute exacerbation of COPD, pulmonary rehabilitation reduces readmission rates and improves functional capacity and health status.

“Following an acute exacerbation of COPD, PR has been shown to be successful in reducing readmission rates as well as eliciting benefits in terms of patient's functional capacity and health status [8e10].”

• cites [8e10]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Hospital Anxiety and Depression Scale is a valid measure commonly used to assess psychological symptoms in chronic illness.

“The HADS is a valid measure, commonly used to assess psychological symptoms in those with chronic illness.”

• cites [30] Zigmond, 1983, The hospital anxiety and depression scale, Acta Psychiatr Scand sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Illness Perceptions Questionnaire-Revised is internally valid in various disease populations.

“The IPQ-R (Supplement 1) is a self-reported measure of patient's illness perceptions and has been shown to be internally valid in various disease populations [29].”

• cites [29] Moss-Morris, 2002, The revised illness perception questionnaire (IPQ-R), Psychol Health sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The cross-sectional nature of the data means that causal assumptions are speculative.

“The cross-sectional nature of the data means that causal assumptions are speculative.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The present study used a technique which limits manipulation by allowing the statistical program to establish possible numbers of clusters.

“However, the present study used a technique which limits manipulation by allowing the statistical program to establish possible numbers of clusters.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Cluster analysis imposes a structure on the data which may not necessarily exist.

“Furthermore, cluster analysis imposes a structure on the data which may not necessarily exist.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is possible that older age in Cluster 1 allows patients to attribute some functional limitations to the process of aging.

“and it is possible that they are therefore more able to attribute some of the functional limitations to the process of aging [41].”

• cites [41] Lazarus, 2007, Inherent ageing in humans: the case for studying master athletes, Scand J Med Sci Sports sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Acute exacerbations are unpredictable and have been suggested to promote constant monitoring of symptoms and hypervigilance in patients with COPD.

“Acute exacerbations are unpredictable and have been suggested to promote constant monitoring of symptoms and hypervigilance in patients with COPD [40].”

• cites [40] Russell, 1998, Patients' explanatory models for heart failure and COPD exacerbations, Clin Nurs Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

In an unstable population of patients, profiles may change as time lapses from the acute exacerbation.

“In an unstable population of patients profiles may change as time lapses from the acute exacerbation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

We cannot be sure about the stability of the three illness profiles over time.

“Furthermore, we can not be sure about the stability of the three illness profiles over time.”

Probably not a substantial claim: may not pass S2 (checkable).

It is unlikely that an education programme would be successful without the promotion of acceptance and control.

“With these considerations in mind it is unlikely that an education programme would be successful without the promotion of acceptance and control.”

May combine two claims.

Emotional representations play a key role in defining clusters in patients with COPD following an acute exacerbation, possibly because symptoms of breathlessness are intimately associated with anxiety.

“It would appear that emotional representations play a key role in defining clusters in patients with COPD following an acute exacerbation, possibly because symptoms of breathlessness are so intimately associated with those of anxiety [37].”

• cites [37] Bailey, 2004, The dyspnea-anxiety-dyspnea cycle–COPD patients' stories of breathlessness: it's scary/when you can't breathe, Qual Health Res sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Patients in Cluster 2 may have actively chosen to avoid information about their disease, prompted by denial or ambivalence about the diagnosis of a degenerative disease with poor prognosis.

“Patients may have actively chosen to avoid information about their disease, prompted by denial or ambivalence about the diagnosis of a disease with a degenerative process and poor prognosis.”

Probably not a substantial claim: may not pass S2 (checkable).

Supporting patients in Cluster 2 ('disengaged') to promote active engagement in treatment such as pulmonary rehabilitation is likely to be very challenging.

“Supporting patients in Cluster 2 ('disengaged') in a way which promotes active engagement in treatment such as PR is likely to be very challenging.”

May combine two claims.

Patients in Cluster 1 ('in control') do not appear overwhelmed by the persistent threat of an acute exacerbation and are able to manage their emotions accordingly, unlike those in Cluster 3 ('distressed').

“Patients in Cluster 1 ('in control') do not appear to be overwhelmed by the persistent threat of an acute exacerbation and are able to manage their emotions accordingly, unlike those in Cluster 3 ('distressed').”