Associations between symptoms, functioning, and perceptions of mastery with global self-rated health in patients with COPD: A cross-sectional study

https://doi.org/10.1016/j.ijnurstu.2007.09.012Get rights and content

Abstract

Background

Self-rated health has been shown to be a significant predictor of mortality. However, there is limited knowledge on what factors contribute to the global perception of self-rated health in patients with chronic obstructive pulmonary disease (COPD).

Objective

To describe the associations between physical and psychological symptoms, physical and mental health functioning, and perceptions of mastery with concurrent and longitudinal global self-rated health (GSRH) in patients with COPD and to determine if gender modifies these relationships.

Design

Cross-sectional analysis of data from a longitudinal clinical trial.

Setting

University medical center in the United States.

Participants

115 patients with moderate to severe COPD.

Methods

GSRH was measured using one question from the Medical Outcomes Study, SF-36 which states, “In general, would you say your health is: excellent, very good, good, fair, or poor”. Physical and psychological symptoms were measured with the Shortness of Breath Questionnaire, Chronic Respiratory Questionnaire (CRQ), and Center for Epidemiologic Studies Depression Scale (CESD); the SF-36 was used to measure physical and mental health functioning; mastery was measured by a sub-scale of the CRQ. The BODE index, a multidimensional disease severity grading system, was also included. Stepwise logistic regression analyses were performed.

Results

In cross-sectional analyses, only disease severity as measured by the BODE index was associated with GSRH [odds ratio, 1.52; 95% confidence interval, CI (1.08, 2.15)]. Stratified analyses by gender showed that the association between the BODE index and the GSRH held up for men, but not for women. Higher perception of symptom control was associated with positive health ratings in women. Subjects with less fatigue at baseline had a lower risk of reporting poor health 12 months later [OR 0.84; 95% CI (0.72, 0.98)].

Conclusions

For patients with COPD, ratings of global health were mostly influenced by measures that reflect their physical state, e.g. disease severity and fatigue. While additional work is needed to better understand gender differences in factors that contribute to GSRH, therapeutic nursing interventions might place greater focus on symptom management if the goal is to improve patients’ perceptions of their global health.

Section snippets

What is known about the topic?

  • Ratings of global health are associated with mortality in diverse clinical and community populations.

  • GSRH is one dimension of the overall assessment of health related quality of life.

What this paper adds

  • Ratings of global health for patients with COPD were mostly influenced by their disease severity and level of fatigue.

  • Depressed mood was not associated with ratings of global health.

  • There are potential gender differences in the factors that shape ratings of global health suggesting that interventions to improve overall perceived health may need to be gender-tailored.

Purpose

The goal of this paper is to describe the extent to which physical and psychological symptoms, physical and mental functioning, and perceptions of mastery contribute to concurrent and longitudinal GSRH in patients with COPD and to determine if gender modifies these relationships.

Methods

The data used for this paper are from a randomized clinical trial (RCT) comparing three treatments for dyspnea self-management in patients with COPD and were obtained from 1995 to 2000. The methods have been reported in-depth elsewhere (Carrieri-Kohlman et al., 2005; Stulbarg et al., 2002) and are therefore described briefly in this paper. Baseline (n=115) and 12 month (n=94) data from subjects with moderate to severe COPD were included in this analysis. The study protocol was approved by the

Results

This sample (n=115) of patients with moderate to severe COPD was primarily Caucasian (85%) and well educated with 69% having at least some college education. Table 1 shows the sample characteristics according to GSRH. While there were no significant differences in pulmonary function between subjects who reported good and poor health, those with poor health had higher BODE scores (+1.2 points, p<0.001). Subjects who reported poor health were significantly younger, had more severe dyspnea,

Discussion

Since an individual's perception of his or her health is associated with survival, the main objective of this paper was to examine what potentially modifiable factors influenced COPD patients’ ratings of their global health (GSRH). The main findings are that although disease severity was associated with greater risks of poor health ratings in men, it was the perception of mastery over the disease that shaped women's ratings of their global health. While dyspnea, a hallmark symptom of COPD, did

Conclusion

Ratings of global health by patients with COPD were for the most part influenced by measures that reflect their overall physical state, e.g. disease severity and fatigue. While additional qualitative work will need to be conducted to understand the influential factors and gender differences that contribute to GSRH, therapeutic interventions should focus on reducing fatigue if the goal is to improve patients’ health perceptions. Since GSRH is a simple measure and can be easily implemented in

Acknowledgments

Competing interests

The authors declare that they have no competing interests.

Author's contributions

H.Q.N. participated in the design and implementation of the study, conducted the data analyses, drafted, and revised the manuscript. D.D.C. participated in the drafting and revision of the manuscript. G.C.K. conceived of the original study, participated in its design and implementation, drafted and revised the manuscript.

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    1

    These authors contributed equally to this work.

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