Associations between symptoms, functioning, and perceptions of mastery with global self-rated health in patients with COPD: A cross-sectional study☆
Section snippets
What is known about the topic?
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Ratings of global health are associated with mortality in diverse clinical and community populations.
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GSRH is one dimension of the overall assessment of health related quality of life.
What this paper adds
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Ratings of global health for patients with COPD were mostly influenced by their disease severity and level of fatigue.
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Depressed mood was not associated with ratings of global health.
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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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Supported in part by NIH R01-NR02131-07 to Dr. Carrieri-Kohlman and NIH Roadmap for Medical Research, 5 K12 RR023265-03 to Dr. Nguyen. Information on this Multidisciplinary Clinical Research Career Development Program can be found at http://nihroadmap.nih.gov. This study was carried out in part in the General Clinical Research Center, Moffitt Hospital, University of California, San Francisco, with funds provided by the National Center for Research Resources, 5 M01 RR-00079, US Public Health Service.
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These authors contributed equally to this work.