Association of psychological flexibility with engagement in pulmonary rehabilitation following an acute exacerbation of chronic obstructive pulmonary disease
Open accessAbstract
This study aimed to investigate (a) the association between psychological flexibility and engagement in pulmonary rehabilitation within 8 weeks following hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and (b) how psychological (in)flexibility presents in this context. A mixed-methods study was conducted. Psychological flexibility during an AECOPD was assessed using The Acceptance and Action Questionnaire-II (AAQ-II) ( n = 41) and the Engaged Living Scale (ELS) ( n = 40). Engagement in post-AECOPD pulmonary rehabilitation was then recorded. Twenty-three patients also participated in cognitive interviews. Psychological flexibility was associated with a greater chance of accepting a pulmonary rehabilitation referral following an AECOPD. Small numbers prohibited analysis on attendance or completion. An AAQ-II score of 11 translated to a 60 (37–82)% probability of accepting a referral to pulmonary rehabilitation and an ELS score of 73 was associated with a 68 (46–91)% probability of accepting. Four themes were extracted from interviews: (1) family values, (2) self as abnormal, (3) ‘can’t do anything’ versus ‘I do what I can’ and (4) disability, and related emotions, as barriers to action. Randomised clinical trials are needed to evaluate interventions designed to increase psychological flexibility (i.e. acceptance and commitment therapy) to support acceptance of pulmonary rehabilitation post-AECOPD.
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ACT may be a suitable approach in this setting.
“ACT may be a suitable approach in this setting for two main reasons [13, 27–30].”
Psychological flexibility is a broad treatment target comprising a range of emotional and motivational factors that may contribute to non-adherence.
“First, psychological flexibility is a broad treatment target comprising a range of emotional and motivational factors that may contribute to non-adherence.”
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References 25 · Cited by 19
Research works printed but not linked: 1
- [13]Elia M Screening for malnutrition: a multidisciplinary responsibility. development and use of the malnutrition universal screening tool (‘MUST’) for adults. Redditch: BAPEN 2003; 5(3): 17.
- Authors
- Fernandes-James, C., Graham, C. D., Batterham, A. M., & Harrison, S. L.
- Affiliations
- North Tees and Hartlepool NHS Foundation Trust (GB)
- Queen's University Belfast (GB)
- Teesside University (GB)
- Corresponding author
- Harrison, Samantha L
- Venue
- Chronic Respiratory Disease
- Publisher
- SAGE Publications
- Published
- 2019-01-01
- Volume
- 16
- Pages
- 1479973119880893-1479973119880893
- ISSN
- 1479-9723 (ISSN-L)
- 1479-9731
- PMC
- PMC6769226
- OpenAlex
- W2975215886
- Cited by
- 19
- References
- 25
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2022: 7 · 2021: 3 · 2020: 3
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Chronic Respiratory Disease (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (publishedVersion, cc-by-nc)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- Funders
- Council Allied Health Professions Research (CAHPR) network (North East hub - small grants scheme)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- psychological flexibility, pulmonary rehabilitation, COPD exacerbations, chronic obstructive pulmonary disease, rehabilitation engagement, acceptance and commitment therapy, Acceptance and Action Questionnaire-II, barriers to action, family values, disability
- MeSH terms
- Acute Disease, Adaptation, Psychological, Aged, Emotions, Female, Disabled Persons, Persons with Disabilities, Humans, Interviews as Topic, Male, Middle Aged, Patient Participation, Surveys and Questionnaires, Self Concept, Disease Progression, Pulmonary Disease, Chronic Obstructive
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