Everyday life activities of people with chronic obstructive pulmonary disease : performance, management and everyday technology use

Background When a person is living with chronic obstructive pulmonary disease (COPD), his/her participation in everyday life activities is challenged due to a complex multitude of symptoms. Moreover, everyday technology utilised in daily life at home and in society also impacts on participation in everyday life activities. Knowledge of everyday life activities and everyday technology use of persons with COPD is sparse but is important to obtain for use in pulmonary rehabilitation. The overall aim of this thesis was to evaluate and explore everyday life activities including everyday technology use in persons with COPD to generate knowledge that can be applied in COPD rehabilitation. Methods To evaluate and explore everyday life activities, both quantitative and qualitative studies have been conducted using a cross-sectional design (Study I, II, IV) and qualitative interviews (Study III). First, a reliability testing was performed to ensure the psychometric evidence of the Everyday Technology Use Questionnaire (ETUQ) (Study I) to apply in the following data collection. Data for Study I were collected among persons both with and without COPD. In Study II, the associations between health-related quality of life (HRQOL) and activities of daily living (ADL) performance, everyday technology use and demographic data were investigated. In Study IV, ADL performance was further explored, and the relationship between observed and self-reported ADL performance and everyday technology use was investigated. Statistical analyses such as Svensson’s method for paired ordinal data, correlational and multiple regression analyses were applied in these studies. In Study III, the experiences and management of everyday life activities were explored through qualitative interviews, which were analysed using content analysis. All included participants in Study IIIV were diagnosed with COPD. Findings An overall finding was that, although different concepts, ADL performance and everyday technology use were related and they were associated with HRQOL among people living with COPD. The personal ADL (PADL) tasks found to be most affected among the participants were related to moving around inside and outside the home, bathing and lower dressing. The instrumental ADL (IADL) tasks most affected were related to cleaning, washing and transportation. The ADL motor skills most challenging for persons with COPD were Positions, Stabilizes, and Endures, and for ADL process skills they were Organizes, Accommodates and Benefits. Inter-rater and test-retest reliability of ETUQ was initially confirmed. The overall ability to use everyday technology was relatively high in relation to the difficulty presented by the technologies included in the ETUQ. However, some participants demonstrated lower ability scores indicating a potential need for support also in using everyday technology. Lastly, the participants experienced a complex juggling when managing their everyday life activities, being constantly aware of bodily symptoms and limitations related to COPD, which meant that valued and pleasurable activities were not in focus and were not prioritised. Conclusion The participants in this thesis were affected by their disease while performing both PADL and IADL tasks in which everyday technology was involved. Moreover, they experienced a complex juggling seeking to manage their everyday life activities being constantly aware of bodily symptoms and limitations related to COPD. It is therefore important in pulmonary rehabilitation to address and support persons with COPD in choosing and performing everyday life activities of personal interest and value for them and to support them in using everyday technology. By evaluating and exploring everyday life activities through the dimensions of doing, and in natural and relevant settings, this thesis can contribute with new insights into the field of COPD

Juggling the management of everyday life activities in persons living with chronic obstructive pulmonary disease

PURPOSE: Evidence regarding everyday life activities in people living with COPD is limited. Such evidence can improve our understanding when designing interventions for pulmonary rehabilitation that aim at increasing or maintaining participation in these activities. The aim of this study was to describe how people living with COPD experience and manage everyday life activities. MATERIALS AND METHODS: The sample comprised four males and four females with an age ranging from 65-87 years. Participants were interviewed in their own homes regarding experiences of performing and managing everyday life activities. Data were transcribed verbatim and analysed using content analysis. RESULTS: Findings from this study comprised the theme "Juggling to manage everyday life activities with COPD" and three categories representing the elements of this theme: (1) consequences of COPD symptoms, (2) adjustment of activities, and (3) contextual aspects. CONCLUSION: This study found the participants with COPD juggling the management of everyday life activities. The juggle generated a manageable daily life, which came at the expense of making deliberate choices and prioritizing everyday life activities that were necessary for participation in valued and engaging activities in order to maintain health and well-being. Implications for Rehabilitation People living with COPD experience a complex juggling between the consequences of COPD symptoms and contextual aspects when managing everyday life activities. The participants had largely accepted their disease and adjusted to their situation. The disease was still described as frustrating and generated less focus on making deliberate choices and prioritizing everyday life activities that are necessary for participation in valued and engaging activities. Health professionals need to support people living with COPD in making deliberate choices in order to continue participating in valued and engaging everyday life activities as they affect health and well-being. Pulmonary rehabilitation should focus more on supporting participation in social relations and on using everyday technologies

Inter-rater and test-retest reliability of the Danish version of the everyday technology use questionnaire

Background: Everyday technologies are naturally integrated in people’s daily life. For older adults and adults living with a chronic disease like chronic obstructive pulmonary disease (COPD), the ability to use technologies for health management has become increasingly important. The aim of this study was to investigate inter-rater and test-retest reliability of the Danish version of the Everyday Technology Use Questionnaire (ETUQ) in a sample of older adults with (n = 23) and without (n = 24) COPD. Material and method: The ETUQ was initially translated in accordance with the dual panel approach and then administered to a sample of 47 participants. Svensson’s method for paired ordinal data was utilized to calculate and analyze reliability. Results: Overall, inter-rater and test-retest reliability of the Danish version of the ETUQ demonstrated excellent percentage agreement (PA) (>75%), although for test-retest reliability, nine items demonstrated fair (53%) to good (73%) agreement. Conclusion: This study supports the use of the Danish version of the ETUQ in a sample of older adults with or without COPD. Application to practice: The Danish version of the ETUQ is an evidence-based evaluation that can reliably contribute to clinical occupational therapy and research in Denmark focusing on everyday technology use

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New Insights into Activities of Daily Living Performance in Chronic Obstructive Pulmonary Disease

Purpose: There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD. Methods: This cross-sectional study involved 84 participants aged 46-87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson's correlation coefficient. Results: The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented. Conclusion: Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation

Association Between Everyday Technology Use, Activities of Daily Living and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Purpose: A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL. Methods: This cross-sectional study included (N=80) participants aged 46-87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis. Results: The regression model explained 50.6% (R2=0.506) of the variation in HRQOL-physical. The following four variables were statistically significantly associated with HRQOL - physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R-2=0.228) of HRQOL - mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL - mental (p=0.009). Conclusion: Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD