Abstract
To the editor,
We thank the authors for their interest in our study, which showed that higher scores on the PRAISE tool predict positive changes in physical activity behaviours following pulmonary rehabilitation [1]. However the PRAISE was not responsive to change following pulmonary rehabilitation. We agree with the authors that this could be due either to limitations in the instrument or limitations in the intervention.
Although our interventions were not specifically developed to enhance self-efficacy, the components of our pulmonary rehabilitation programs were aligned with current international recommendations [2]. The average improvement seen in our other measure of self-efficacy, the Chronic Respiratory Disease questionnaire Mastery domain, exceeded the minimal important difference [3] and its effect size was more than double that of the PRAISE (0.45 vs 0.21). These data support our conclusion that PRAISE may not be the most responsive instrument for measuring such changes. We agree that further refinements of the current pulmonary rehabilitation model may also be useful to optimise the behavioural outcomes of pulmonary rehabilitation, using insights from Social Cognitive Theory [4]. We look forward to development of such a model that could be tested for efficacy in clinical trials.
The results of our study [1] support the authors’ contention that a baseline assessment of self-efficacy may be important to optimise pulmonary rehabilitation components and outcomes. Baseline PRAISE scores in our study ranged widely, from 28 to 60 (maximum possible score is 60). Higher PRAISE scores were an independent predictor of reduction in sedentary time following the program, suggesting that individuals who enter pulmonary rehabilitation with high self-efficacy are likely to do well. The pulmonary rehabilitation community must now develop a more supportive environment for those who enter our programs with lower self-efficacy, to optimise motivation, experiences and health outcomes.
Citation
Response to letter to the Editor re ‘Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool predicts reduction in sedentary time following pulmonary rehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD)’