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Correspondence |

What Is the Pulmonary Rehabilitation Adapted Index of Self-Efficacy Tool Actually Measuring?What Is the PRAISE Tool Actually Measuring? FREE TO VIEW

Zachary S. DePew, MD; Roberto Benzo, MD, FCCP
Author and Funding Information

From the Breathing and Behavior Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester.

Correspondence to: Roberto Benzo, MD, FCCP, Breathing and Behavior Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, 201 First St SW, Rochester, MN 55905; e-mail: benzo.roberto@mayo.edu


Funding/Support: Dr Benzo is supported by the National Institutes of Health [Grant 1R01HL094680-01].

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1123-1124. doi:10.1378/chest.11-2859
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We read with great interest the study by Vincent et al1 recently published in CHEST (December 2011). We commend the authors for expanding the field of self-efficacy research for patients with COPD.

The Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) tool contains 15 items, 10 assessing “general” self-efficacy and five assessing self-efficacy specific to pulmonary rehabilitation (PR). The PRAISE tool showed a significant response following PR; however, given the task-specific nature of the self-efficacy construct,2,3 we wonder if the increase in self-efficacy was predominantly related to an improvement in the PR-specific items rather than in general self-efficacy. We believe the article would have benefitted from an analysis of individual item performance. If the improvement had been related to PR items only, it may have allowed for abbreviation of the tool. On the other hand, improvement of the general self-efficacy items would suggest that PR benefited areas other than mastery of exercise, such as problem-solving and coping skills (critical aspects of behavioral change for self-management), even though changes in behavior following PR were not measured in this study.

Our interest in exploring the task-specific nature of the self-efficacy construct emerges from our own research. We recently completed the validation of two physical activity questionnaires in patients with COPD compared with objectively measured physical activity, and we included self-efficacy as a possible covariate. We found that general self-efficacy (Stanford Self-Efficacy for Managing Chronic Disease 6-Item Scale) was not significantly associated with physical activity. If the proposed analysis confirms that the PR-related items were responsible for the measured improvement, then our results are congruent and collectively highlight the importance of creating task-specific self-efficacy tools.

We agree with the authors that self-efficacy for activities prescribed in PR may contribute to a critical behavior: adherence to the PR program. Regrettably, the pre-PR PRAISE score showed no association with completion of the program. There were, however, correlations between the change in the Chronic Respiratory Questionnaire emotion and mastery domains (which may represent improved behaviors) and the change in the PRAISE score following PR. We believe a mediation analysis, as described previously,4,5 is the most appropriate way to determine if the change in self-efficacy is responsible for the improvements in these domains rather than the direct effect of the PR itself.

We believe the proposed analyses will help determine what the PRAISE tool is actually measuring. We are convinced that additional research aimed at understanding the behavioral aspects of PR is critically needed.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

Vincent E, Sewell L, Wagg K, Deacon S, Williams J, Singh S. Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool. Chest. 2011;1406:1534-1539 [CrossRef] [PubMed]
 
Bandura A. Self-Efficacy: The Exercise of Control. 1997; New York, NY Freeman and Company
 
Kaplan RM, Atkins CJ, Reinsch S. Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychol. 1984;33:223-242 [CrossRef] [PubMed]
 
Dishman RK, Motl RW, Saunders R, et al. Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Prev Med. 2004;385:628-636 [CrossRef] [PubMed]
 
Dutton GR, Tan F, Provost BC, Sorenson JL, Allen B, Smith D. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. J Behav Med. 2009;323:270-277 [CrossRef] [PubMed]
 

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References

Vincent E, Sewell L, Wagg K, Deacon S, Williams J, Singh S. Measuring a change in self-efficacy following pulmonary rehabilitation: an evaluation of the PRAISE tool. Chest. 2011;1406:1534-1539 [CrossRef] [PubMed]
 
Bandura A. Self-Efficacy: The Exercise of Control. 1997; New York, NY Freeman and Company
 
Kaplan RM, Atkins CJ, Reinsch S. Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychol. 1984;33:223-242 [CrossRef] [PubMed]
 
Dishman RK, Motl RW, Saunders R, et al. Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Prev Med. 2004;385:628-636 [CrossRef] [PubMed]
 
Dutton GR, Tan F, Provost BC, Sorenson JL, Allen B, Smith D. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. J Behav Med. 2009;323:270-277 [CrossRef] [PubMed]
 
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