Changes in COPD-related anxiety symptoms during pulmonary rehabilitation: a prospective quantitative and qualitative study.

Background: Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPD-related anxiety symptoms over the course of a PR program. Methods: Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPD-related anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach. Results: A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception. Conclusions: COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program.

An exercise and patient education intervention to reduce pain and physical limitations in adults with acetabular dysplasia: study protocol for a process evaluation integrated within a randomised controlled trial (the MovetheHip trial).

BACKGROUND: The Movethehip trial investigates the effectiveness of an exercise and patient education intervention for adults with acetabular dysplasia. The intervention involves eight tailored one-to-one sessions with trained providers who employ supportive feedback tools. The present protocol reports a planned process evaluation, which aims to determine how the intervention functions by examining the implementation of the intervention (process, dose and reach), its acceptability, mechanisms of change and the influence of contextual factors. METHODS: Two hundred trial participants aged 18-50 years will be recruited from a University Hospital in Denmark and randomised to the intervention or control group. Approximately ten providers will deliver the intervention. The process evaluation adopts a concurrent mixed-methods design. The implementation will be assessed using self-report questionnaires (at baseline and 6-month follow-up), training records and semi-structured focus group interviews with intervention providers (n = 10) and healthcare managers (n = 4-6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15-20 purposefully sampled participants and by measuring changes in health outcomes (self-reported pain, physical functioning and quality of life completed at baseline and at 3- and 6-month follow-up). Additionally, change will be measured through an explorative examination of associations between dose and change in health outcomes, applying simple linear regression models. The acceptability of the intervention and the influence of contextual factors will be explored through one-to-one participant interviews and focus group interviews with 4-6 healthcare managers. The interviews will focus on expectations, experiences, events, personal understandings and interaction with interpersonal and organisational aspects. Interview data will be analysed using theoretical thematic analyses, and findings will be merged with quantitative data and reported jointly on a theme-by-theme basis. DISCUSSION: The process evaluation conducted as part of the MovetheHip trial will illuminate how the intervention functions, and if the intervention is proven effective, the findings of the evaluation will contribute to pinpoint how the intervention may be optimised to facilitate future up-scaling and implementation. TRIAL REGISTRATION: The MovetheHip protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region. ClinicalTrials, NCT04795843. Registered on 20 March 2021.

Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards.

INTRODUCTION: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. AIM: To explore the process of preparing discharge for patients with COPD in a hospital setting. METHOD: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. RESULTS: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. CONCLUSION: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.

Exploring needs, barriers to, and facilitators of rehabilitation exercise following revision hip replacement - A grounded theory study.

PURPOSE: Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR. MATERIALS AND METHODS: Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical. FINDINGS: From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity. CONCLUSIONS: This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR.

Patients' rehabilitation exercise experiences after revision total hip replacement may serve as guidance for clinicians.A need exists to tailor individual rehabilitation interventions and clinicians' approaches to optimize patients' engagement and rehabilitation exercise adherence following revision total hip replacement.Clinicians can tailor rehabilitation exercise for patients with revision total hip replacement by focusing on therapeutic relationships, support needs, and physical function while incorporating insights from previous rehabilitation exercise experiences.An important goal of rehabilitation exercise is to enhance patient engagement, thereby facilitating the integration of rehabilitation exercises into the patients' everyday life.

How does mHealth influence consulting practice between health professionals and individuals with low back pain? - A qualitative study from the perspective of health professionals.

PURPOSE: This study explored how health professionals experience in what way a digital self-monitoring solution influences their consulting practice targeting individuals with low back pain. MATERIAL AND METHODS: This was a qualitative study adopting a constructivist grounded theory approach. Nineteen health professionals participated in the pilot test of the digital self-monitoring solution BackTrace. Data were collected cross-sectionally and consisted of: (a) audio recordings from focus groups with health professionals, (b) field notes from participant observation of online meetings with health professionals, (c) field notes from participant observations of consultations between health professionals and individuals with low back pain and (d) audio recordings from workshops with health professionals. RESULTS: Two main themes and one sub-theme were identified, describing how BackTrace enabled more focused consulting practices, supported patient-self management and improved the relationship between individuals with low back pain and health professionals. Barriers were identified describing how the implementation of digital health solutions required a change in workflow, resources and culture - as well as management support. CONCLUSIONS: Findings indicated a need for a change at the system level, including a changed view of digitisation in healthcare systems containing a more supporting approach.

Low back pain is a leading cause of disability which not only impacts physically but restricts quality of life.This study shows how health professionals experience in what way digital self-monitoring solutions influence their consulting practices targeting individuals with low back pain.A digital self-monitoring solution may contribute to a more focused consulting practice and improve the quality of the relationship between individuals with low back pain and health professionals but require changes at a system level.A change in workflow and culture is recommended if digital health is to be a success.

Filling the gap in service provision. Partners as family carers to people with Parkinson's disease: A Scandinavian perspective.

OBJECTIVES: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway. METHODS: A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches. RESULTS: The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role. DISCUSSION: A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family.

Perspectives of people with Parkinson's disease and family carers about disease management in community settings: A cross-country qualitative study.

AIM: To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease. BACKGROUND: Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting. DESIGN: A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ. METHODS: Individual semi-structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta-ethnographic approach was used to analyse and synthesise cross-national findings. RESULTS: Forty-seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub-themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well-being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management. CONCLUSIONS: An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long-term conditions. PATIENT OR PUBLIC CONTRIBUTION: The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings. RELEVANCE TO CLINICAL PRACTICE: This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey.

Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study.

BACKGROUND: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. OBJECTIVE: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. METHODS: A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. RESULTS: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. CONCLUSIONS: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. PATIENT OR PUBLIC CONTRIBUTION: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.

An inconvenience to the nurse's practice: A Foucault-inspired study of ethnic minority patients.

Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed 'figure of inconvenience' in which ethnic minority patients were classified and assigned a specific subjection illustrating them as 'inconvenient' to the nurse's practice. Concurrently, their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark.

Comparing exercise and patient education with usual care in the treatment of hip dysplasia: a protocol for a randomised controlled trial with 6-month follow-up (MovetheHip trial).

INTRODUCTION: Surgery is not a viable treatment for all patients with hip dysplasia. Currently, usual care for these patients is limited to a consultation on self-management. We have shown that an exercise and patient education intervention is a feasible and acceptable intervention for patients not receiving surgery. Therefore, we aim to investigate whether patients with hip dysplasia randomised to exercise and patient education have a different mean change in self-reported pain compared with those randomised to usual care over 6 months. Furthermore, we aim to evaluate the cost-effectiveness and perform a process evaluation. METHODS AND ANALYSIS: In a randomised controlled trial, 200 young and middle-aged patients will be randomised to either exercise and patient education or usual care at a 1:1 ratio through permuted block randomisation. The intervention group will receive exercise instruction and patient education over 6 months. The usual care group will receive one consultation on self-management of hip symptoms. The primary outcome is the self-reported mean change in the pain subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS). Secondary outcomes include mean changes in the other HAGOS subscales, in the Short Version of the International Hip Outcome Tool, in performance, balance and maximal hip muscle strength. Between-group comparison from baseline to 6-month follow-up will be made with intention-to-treat analyses with a mixed-effects model. Cost-effectiveness will be evaluated by relating quality-adjusted life years and differences in HAGOS pain to differences in costs over 12 months. The functioning of the intervention will be evaluated as implementation, mechanisms of change and contextual factors. ETHICS AND DISSEMINATION: The study protocol was approved by the Committee on Health Research Ethics in the Central Denmark Region and registered at ClinicalTrials. Positive, negative and inconclusive findings will be disseminated through international peer-reviewed scientific journals and international conferences. TRIAL REGISTRATION NUMBER: NCT04795843.

Feasibility and acceptability of a six-month exercise and patient education intervention for patients with hip dysplasia: A mixed methods study.

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery. DESIGN: Feasibility study. METHODS: The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms. RESULTS: Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5-17) HAGOS pain points, improvements in all subscales were 1-11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04-0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64-74) to 75 (IQR: 72-80) centimetres; posteromedial: 104 (IQR: 94-112) to 119 (IQR: 112-122) centimetres and posterolateral: 98 (IQR: 89-109) to 116 (IQR: 108-121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30-44) to 52 (IQR: 45-58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1,581:1,872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harms. CONCLUSION: Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Toward Nurses' Transformative Agency in Transitional Care for Older Adults: A Change-Laboratory Intervention.

Mobilization of nurses' agency across healthcare sectors is needed to counter challenges associated with older adults' transitions between hospital and primary care. Based on Cultural Historical Activity theory and the Change Laboratory method, we developed a learning intervention with 16 nurses. The aim was to foster the nurses' transformative agency to improve care. Video-recording of nine learning sessions were transcribed and analyzed. Results demonstrated that shared transformative agency exhibited as an emergent phenomenon crossing sectoral boundaries as a prerequisite for change in transitional care. The nurses progressed from acting as individuals criticizing the current conditions to collectively forming a vision around a transitional care model. This was nurtured through the nurses' negotiations which included a recognition of sharing similar challenges deriving from the healthcare organization and related financial restrictions, and conflicting healthcare and nursing ideals across healthcare sectors. The evolution of transformative agency was grounded in a professional nursing identity.

Det er nødvendigt at mobilisere sygeplejerskers ejerskab for udvikling på tværs af sundhedssektorer for at imødegå udfordringer i ældre medicinske patienters overgange mellem hospital og primærsektor. Med udgangspunkt i virksomhedsteori og Change Laboratory metoden udviklede vi en læringsintervention for 16 sygeplejersker. Formålet var at fremme sygeplejerskernes transformative ejerskab for at kunne forbedre sygeplejen. Vi transskriberede og analyserede videooptagelser af ni læringssessioner. Resultaterne viste et spirende fælles transformativt ejerskab blandt sygeplejerskerne på tværs af sektorer som en forudsætning for at kunne forandre den tværsektorielle pleje. Sygeplejerskerne gjorde fremskridt idet de flyttede sig fra at give individuel kritik af forholdende, til at samarbejde om at skabe en fælles vision for pleje ved overgange.Fremskridtet opstod, fordi sygeplejerskerne erkendte, at de på tværs af sektorer delte de samme udfordringer, som er forårsaget af organiseringen af sundhedsvæsenet og økonomiske begrænsninger samt modstridende idealer mellem sundhedsvæsenet og sygeplejeidealer på tværs af sundhedssektorer. Udviklingen af sygeplejerskernes transformerende ejerskab var forankret i en sygeplejefaglig professionsidentitet.

Systemic contradictions as causes to challenges in nurses' transitional care: A change laboratory intervention.

BACKGROUND: Transitional care involves coordination of care for patients transitioning between primary care and hospital care. This necessitates collaboration with patients, health professionals and organizations with different goals for patient care. This can result in fragmented patient care pathways. Education of health professionals is a means to improve transitional care. We therefore developed a learning intervention in order to enable nurses to develop transitional care. OBJECTIVE: The objective was to understand how participants identified needs for development can improve transitional care. DESIGN: The design was that of a formative intervention design based on Cultural Historical Activity Theory. SETTING: A regional hospital and a primary care department in a municipality in Denmark. PARTICIPANTS: Nine health professionals from primary care services and seven health professionals from hospital services. METHOD: The change laboratory method and the principle of double stimulation guided the facilitation of the learning intervention, which consisted of nine learning sessions (from May to October 2019). A quantitative and qualitative analytical framework was used for data analysis. RESULTS: The participants identified needs for development, including a wish to involve patients and their next of kin more and to emphasise relational care. Participants developed an appreciation of challenges concerning collaboration between nurses and the formation of nursing practice. Furthermore, participants began to view challenges as caused by a systemic contradiction between nurses' preoccupation with bureaucratic and managerial demands and patients' expectations of coherent care in transitional care. CONCLUSION: The process of understanding challenges enabled the participants to change their perception from a need to solve problems as they appear on the surface to a need to address underlying systemic contradictions. This possibly has far-reaching consequences for long-term processes underpinning the development of practice and may serve as an alternative to expedient problem solving.

'Striving for normality' when coping with Parkinson's disease in everyday life: A metasynthesis.

BACKGROUND: Parkinson's disease is a chronic, progressive neurodegenerative disease which affects more than ten million people worldwide. Living with Parkinson's disease has a high impact on everyday life, and may affect quality of life negatively. Individualized coping strategies are needed to deal with the disease on a daily basis and still enjoy a social life. OBJECTIVE: The aim of this study was to identify and describe strategies for coping adopted by individuals living with Parkinson's disease in their daily lives. DESIGN: The study is designed as a meta-ethnographic metasynthesis and follows Sandelowski and Barroso's guidelines for synthesizing qualitative research. DATASOURCES: Based on an exhaustive literature search in the following databases: CINAHL, MEDLINE, PsychINFO, Scopus and Swemed, as well as Mednar, parkinson.org, Google Scholar and OpenGrey, with no limit on the search date, 14 articles were included. REVIEW METHODS: The data were analyzed through a taxonomic and inductive analysis focusing on coping with Parkinson's disease in daily life. RESULTS: The findings revealed that the overarching motivation for patients to cope with Parkinson's disease was maintaining normality and preserving the self. The coping strategies used were: Staying independent, Focusing on the present and Avoiding challenging situations. CONCLUSIONS: Coping with Parkinson's disease is an ongoing and complex process of balancing the strategies used, while holding on to the 'self' that pre-dated Parkinson's disease, and at the same time adjusting one's identity to embrace living with a chronic condition. In this process, optimism and positive thinking would seem to be very fruitful. Further, the synthesis revealed that relatives often act as informal caregivers and hence as an important support in daily life. Healthcare professionals must know about coping strategies in order better to support the patients.

Living with the risk of being infected: COPD patients' experiences during the coronavirus pandemic.

AIMS: To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD. BACKGROUND: Distancing measures aim to break the coronavirus transmission chains. Physical separation from social networks and social isolation are correlated with anxiety and depression. People with a chronic obstructive lung disease are particularly vulnerable due to the increased risk of a serious course of illness, so therefore many of them choose self-isolation to protect themselves from COVID-19. DESIGN: A qualitative exploratory study using individual semi-structured interviews. METHODS: From June-September 2020, 13 participants were recruited through advertisements on Facebook as a convenience sample for semi-structured individual interviews. The interviews took place through virtual platforms or in physical meetings. Data were analysed using Ricoeur's phenomenological approach, involving naïve reading, a structural analysis and a critical interpretation strategy. The study has been reported in line with COREQ guidelines. FINDINGS: Living with the threat of being infected with coronavirus has greatly affected everyday life for patients with COPD. The nagging fear of coronavirus as a death threat was a dominant feeling, together with anxiety, loneliness and hope. With self-isolation, followed concerns of being forgotten and thoughts of the future, balancing between fearing the worst, and hoping the best. CONCLUSIONS: Patients with moderate to severe COPD feel compelled to self-isolate, as they fear dying from COVID-19. The study revealed a need for proactive contact with health professionals to calm the patients' feelings of deprivation, loneliness, hopelessness and anxiety. RELEVANCE TO CLINICAL PRACTICE: Information about the patient's perspective may be used to develop targeted interventions aimed at giving adequate information, supporting hope, implementing digital or virtual solutions to keep in contact and avoid the feeling of being alone and forgotten during a pandemic crisis.

Mealtime challenges in patients with chronic obstructive pulmonary disease: Who is responsible?

AIMS: To explore experiences of, and practices related to, mealtime challenges in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Nutritional status is a significant indicator of prognosis and outcome in patients with COPD. Preventing unintended weight loss and helping patients regain weight are important nursing tasks. Dietary supplements have been effective in treating underweight in cases of stable COPD. However, compliance with long-term interventions is quite low. Improving nutritional intake through knowledge of meal-related challenges is the key to making further progress in preventing unintended weight loss. DESIGN: This study employed an ethnographic design using the go-along method. METHODS: From September 2018-June 2019, 34 hr of meal-related observations and informal conversations with purposefully selected patients (n = 15) were completed at a Danish respiratory medicine ward and in patients' homes. We analysed the empirical data using a Ricoeur-inspired method. Reporting adheres to the COREQ Checklist. FINDINGS: In this study, we identified the absence of professional responsibility as a main challenge. Mealtimes appeared to be relegated to a matter of nutrition, and common practices surrounding mealtimes were no longer observed. Patients became dependent individuals who had to settle for the food available. In addition, physiological challenges often resulted in patients re-evaluating the benefits of eating, concluding that it was not worth the effort and therefore not eating. Furthermore, patients were hesitant to communicate their needs, which left a number of nonverbalised challenges unattended. CONCLUSIONS: Overall, meal-related challenges pose a risk of unintended weight loss, and the health professionals' work with mealtimes lacks a coordinated, systematic approach. Further research is needed to develop or implement interventions that can accommodate mealtimes. RELEVANCE TO CLINICAL PRACTICE: This study contributes valuable knowledge that can be used to improve the quality of nursing care and prevent unintended weight loss in patients with COPD.

Behavioural modes of adherence to inspiratory muscle training in people with chronic obstructive pulmonary disease: a grounded theory study.

PURPOSE: Our aim was to develop a theoretical account of the behavioural pattern of adherence to home-based inspiratory muscle training (IMT) in people with chronic obstructive pulmonary disease (COPD), performed as two daily sessions of 30 breaths with mechanical threshold loading. METHODS: This was a qualitative study based on the classic grounded theory method. We conducted interviews with people living with COPD recruited after completion of 6 weeks of outpatient pulmonary rehabilitation program in 2015. Concurrently, we generated data and performed analyses by means of constant comparative analysis and theoretical sampling that focused on the behavioural characteristics of adherence to IMT. RESULTS: We achieved theoretical saturation of substantive codes with 33 interviews, nine of which were with men. The participants' mean age and forced expired volume in the first second were 65 (SD 8) years and 59.1 (SD 13.9) percent of predicted, respectively. Seventeen participated in face-to-face interviews, and 16 participated in telephone interviews. The core category "Preserving Integrity" emerged as representative of the primary pattern of behaviour related to the inspiratory muscle-training regimen. Through this pattern, the participants resolved the main concern of losing integrity. Preserving Integrity involved three behavioural modes of adherence to home-based IMT: evading, misgiving, and involving modes. CONCLUSIONS: The participants' behavioural modes regarding adherence revealed patterns of both intended and unintended nonadherence. In particular, support offered by healthcare professionals should target people with unintended nonadherence and scepticism about the effects of IMT to maximise the possibility of adherence. Implications for rehabilitation When implementing inspiratory muscle training, healthcare professionals should be prepared to spend considerable time providing attention and support to participants who feel challenged during the execution of inspiratory muscle training. Support offered by healthcare professionals should target people with scepticism about the effects of inspiratory muscle training to maximise the possibility of adherence. Intended adherence to inspiratory muscle training appeared to be firmly rooted, which means that healthcare professionals can pay less attention to patients with strong intentions to ensure adherence.

Adherence to home-based inspiratory muscle training in individuals with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an incurable progressive illness characterized by airflow limitation and respiratory failure. Inspiratory muscle training (IMT) combined with pulmonary rehabilitation increases inspiratory muscle strength and endurance, and it decreases dyspnoea. Little is known about IMT adherence, and in the present study, we aimed to evaluate adherence to home-based IMT used with automatic internet-based feedback, in patients with chronic obstructive pulmonary disease. METHOD: The adherence was evaluated at an individual level by completing a before-and-after comparison between two groups. Over a 12-week study period, the participants performed two daily sessions of 30 breaths with a mechanical threshold loading training device. They were randomly assigned to either a group of people who self-reported their perceived exertion during breathing and who received automatic internet-based feedback regarding their next threshold loadings, or a group of people who performed IMT with 30% maximal inspiratory pressure and who received no feedback. RESULTS: The group of patients who self-reported their perceived exertion showed significantly better training adherence compared with the group of patients who received no feedback. CONCLUSION: Adherence was greater among patients who self-reported their perceived breathing exertion and received automatic internet-based feedback on the next threshold loadings compared with patients who self-reported training sessions without feedback.

Behavioural typologies of experienced benefit of psychomotor therapy in patients with chronic shoulder pain: A grounded theory approach.

In this study we aimed to develop a theoretical account of the experienced benefit of psychomotor therapy in addition to treatment as usual in patients with chronic shoulder pain. The qualitative study design was based on a grounded theory approach. Open-ended face-to-face interviews were conducted after treatment was completed. We generated data and performed analyses by constant comparative analysis and theoretical sampling that focused on the patients' behavioural characteristics related to the experienced benefit of psychomotor therapy. We conducted 12 interviews, eight of which were with men. "Regaining capability" emerged as representative of the pattern of behaviour. Through this pattern, the patients resolved concern about losing capability. Regaining capability involved three behavioural typologies: taking advice, minding the body, and encompassing life changes. The patients' behavioural typologies revealed different levels of life changes. Psychomotor therapy offered the patients in our study new and better ways of coping with their shoulder pain.